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Category: Your Medicare plan coverage

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How to get a Refund of Overpaid Premiums and Copayments
This fact sheet [from the Centers for Medicare and Medicaid Services] explains how people with Medicare can get paid back for Medicare drug plan copayment and/or premium amounts they may have overpaid ...

Part D Drugs / Part D Excluded Drugs
This table provides Part D coverage clarifications for specific products/drugs/drug categories in accordance with statutory and regulatory requirements for Part D drugs.  This is not an exhaustiv ...

Notes on Medical Power of Attorney
If you are completing a Medicare Part D application for another person and wish to sign the application on behalf of the Medicare beneficiary, you must have a Power of Attorney that covers healthcare ...

What are Bonus Drugs and how do they work with my Medicare Part D prescription drug plan?
Is it possible to have certain prescription drugs that are covered under my Medicare Part D prescription drug plan when these same medications are actually excluded from the Medicare Part D program? ...

Do I really need my Medicare Part D prescription drug plan?
This is a difficult question to answer. As most people know, the Medicare Part D program is voluntary and you are always free to go without prescription drug coverage or even dis-enroll from your pre ...

Medicare Part D Coordination of Benefits with Other Programs. Who Pays First?
If you are confused about who pays first when a beneficiary has a Medicare Part D plan and other prescription drug coverage, you are not alone.  The chart below is provided by CMS (The Centers fo ...

Will I be able to get coverage for the new generic LipitorĀ® (atorvastatin) on my 2012 Medicare prescription drug plan?
Maybe, depending on your Medicare Part D prescription drug plan.  As a note, the name-brand drug Lipitor® is the best-selling medication used by about 4.3 million people in America alone for ...

CMS Memorandum: Lower Cash Price Policy
In 2006, the  Centers for Medicare and Medicaid Services (CMS) released the Lower Cash Price Policy anticipating that some Medicare Part D prescription drug plan beneficiaries would find lower c ...

10 Reasons Why You May Be Paying Full Price For Your Medications - 1. Member ID Card Problems
Help, I just tried to use my Medicare Part D plan and was charged full price for the cost of my medications.  How is this possible?If you are being charged full price for your medications when yo ...

Prescription Pathway (sm) increases PDP Formulary to include BiDil (r)
On January 22, 2007, Prescription Pathway (sm) and the National Association for the Advancement of Colored People (NAACP), New England Conference announced in a press release that all three of the Pre ...

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I enrolled into a new 2017 Medicare Part D plan and still have not received my Member ID card. What should I do?
(1)  If you have received an enrollment confirmation or “Welcome” letter from your 2017 Medicare prescription drug plan, the letter should include your: (1) Member ID number, (2) P ...

I have the same Medicare drug plan as last year, so why am I paying more for my 2016 medications?
Even if you did not change Medicare plans during the annual Open Enrollment Period, there are a number of possible reasons why you are paying more for your prescriptions in 2016.    ...

Why you may be paying more for your medications in 2016: Changes in 2016 prescription co-payments or cost-sharing designs
Your Medicare Part D plan's cost-sharing structure (how the plan's formulary is divided into drug tiers and the cost-sharing per tier) directly influences your medication costs.  When a new drug ...

Why you may be paying more for your medications in 2016: Your Medicare Part D prescription drug plan has a deductible change.
Your Medicare Part D plan's Initial Deductible affects your prescription drug costs in that you are responsible for 100% of your drug costs until you meet your plan's Initial Deductible.  After y ...

Why you may be paying more for your medications in 2016: Increases in your 2016 prescription co-payments or cost-sharing
Very few Medicare Part D plans keep their cost-sharing (co-payments and/or co-insurance) the same from year to year.  Rather, your portion of your prescription costs has a tendency to rise.  ...

What is the 2016 Initial Coverage Limit and how does the ICL work?
The 2016 standard Initial Coverage Limit (ICL) is $3,310. The Initial Coverage Limit is the measured by the retail cost of your drug purchases and is used to determine when you leave your Medicare ...

What to do if you are still waiting for your 2016 Medicare Part D prescription drug plan Member ID card.
If you still have not received your new 2016 Medicare Part D or Medicare Advantage plan Member ID card, please contact your Medicare plan’s Member Services department - confirm your enrollment, ...

What is the 2015 Initial Coverage Limit (ICL) and how does the ICL work?
The Initial Coverage Limit is the number that determines when you leave your Medicare Part D plan's Initial Coverage Phase and enter into the Donut Hole or Coverage Gap.  The 2015 Initial Coverag ...

Still waiting for your new or replacement 2015 Medicare Part D prescription drug plan Member ID card?
If you still have not received your new 2015 Medicare Part D or Medicare Advantage plan Member ID card, please contact your Medicare plan’s Member Services department and ask that a new card be ...

When a 2015 Medicare drug plan states a $1 or 20% copay, is that copay the same at all pharmacies and what about cost-sharing prices during the deductible?
The answer depends on your chosen 2015 Medicare plan. Two important factors influence co-payment pricing: (1) whether your Medicare prescription drug plan uses preferred network pharmacy pricing ...


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.