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Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Browse the Most Viewed and Newest Medicare Part D FAQs
If you still have questions, please contact us through our Online Help Desk.

Most Viewed FAQs
What is a Medicare Part D plan?
Medicare Part D prescription drug plans provide insurance coverage for your out-patient prescription drugs - so Medicare Part D plans work just like any other types of insurance: (1) you usually pa . . .

What is SLMB or a Specified Low Income Medicare Beneficiary?
SLMB is one type of Medicare Savings Program for the "Specified Low - Income Medicare Beneficiary" and, according to the Centers for Medicare and Medicaid Services (CMS), SLMB is defined as: "A Medic . . .

I wish to drop my Medicare Part D prescription drug plan coverage - What should I do?
In general,  you can only drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the Annual Open Enrollment Period (AEP) -- that runs each year from Octob . . .

How will I choose between a stand-alone Medicare Part D prescription drug plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)?
Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs) . . .

What are the Medicare Part D Special Enrollment Periods (SEP)?
A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD) outside of the A . . .

What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap?
Starting back in the 2011 Medicare Part D plan year, a discount or co-insurance (cost-sharing) was introduced to reduce the cost of generic and brand-name prescription drugs purchased by non-LIS . . .

I am considering changing my prescription drug coverage to the Humana Walmart-Preferred Rx Plan and I was wondering if I can only go to Walmart for my prescriptions?
No, you do not have to use Walmart as your only pharmacy.  The Humana Medicare Part D plans include over 50,000+ pharmacies in their pharmacy network. However, you may pay much more for your . . .

If I decide not to join any Medicare prescription drug plan, and I do not have any other prescription coverage, how long will I have to pay the late-enrollment premium penalty?
Probably forever.  The late-enrollment premium penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D prescription drug plan (o . . .

How does the Income-Related Monthly Adjustment Amount (or IRMAA) affect me and my Medicare plan premiums?
If you are paying IRMAA (the Income-Related Monthly Adjustment Amount), this means that, based on your income, you will pay higher premiums for your Medicare Part B and Medicare Part D coverage.As not . . .

What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money?
The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare to help low-income Medicare beneficiaries pay their Medicare . . .

Newest FAQs
Do you have a Donut Hole calculator or a way to estimate my annual Medicare Part D spending?
Yes.  Our Medicare Part D Donut Hole calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and . . .

What is the Medicare Advantage Open Enrollment Period (MA OEP)?
The Medicare Advantage Open Enrollment Period (MA OEP) is another enrollment period allowing people currently enrolled in a Medicare Advantage plan (MAPD or MA) an opportunity to change Medicare Advan . . .

Is there a Special Enrollment Period for Medicare beneficiaries affected by a Major Disaster like a hurricane, typhoon, wildfire, flood, or earthquake?
Yes.  If you live in an area where the Federal Emergency Management Agency (FEMA) declared an emergency or major disaster, and you were not able to take advantage of an enrollment period (such as . . .

How much can the cost of a common generic drug vary between Medicare Part D plans and pharmacies?
As shown in the actual examples below, your generic drug costs can vary widely between Medicare Part D plans and between the pharmacies used by the Medicare Part D plans.A little background on drug pr . . .

How will my Medicare Part D prescription drug plan actively fight the opioid epidemic?
Starting in 2019, your Medicare Part D plan (MAPD or PDP) will implement a drug management program (or drug utilization management) to monitor and limit at-risk Medicare beneficiaries’ access to . . .

Can I compare my Medicare Part D retail drug costs to the the estimated cost using a non-Part D Drug Discount card?
Yes.  You can use our Medicare Part D Drug Finder (Q1Rx.com) to see how all Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include drug coverage (MAPDs) in your . . .

What is indication-based utilization management and how will it affect Medicare Part D plan members?
Indication-based utilization management (or indication limitations) is a newly introduced type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan . . .

Do you have an online Formulary Browser that I can use to see the prescriptions covered by my Medicare Part D plan?
Yes.  We have our Formulary Browser online that includes every Medicare Part D and Medicare Advantage plan formulary or drug list and all formularies are formatted for alphabetical browsing.  . . .

What discount will I receive for my tier 5 specialty drugs when I am in the Medicare Part D Donut Hole?
It depends on the drug.  The formulary drug tier (such as a Tier 5 Specialty Drug) does not affect your Donut Hole discount.Instead, the discount you receive on your medications when reaching the . . .

How do I get a refund for over-paid Medicare Part D premiums and co-payments?
The Centers for Medicare and Medicaid Services (CMS) provides a "tip sheet" explaining how Medicare beneficiaries can receive a refund for their overpaid Medicare drug plan copayment and/or premiu . . .


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Q&A of the Day
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General Medicare Part D (PDPs and MAPDs)
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Medicare Savings Account Plans (MSA)
Choosing a Medicare Plan
Star Ratings & Medicare Plan Quality
Medicare Part D Enrollment
ANOC: Annual Plan Changes
Changing Medicare Part D Plans
Medicare Enrollment Periods (IEP and AEP)
Special Enrollment Periods (SEPs)
Medicare Plan Disenrollment
Late-Enrollment Penalty (LEP)
Initial Deductible
Cost-sharing: What You Pay
Paying Your Premiums
Extra Help - LIS - Medicaid
IRMAA: Higher Incomes and Costs
Living with Your Medicare Part D Plan
Explanation of Benefits (EOB)
Pharmacies and Part D
Retail Drug Pricing
Straddle Claims
Understanding Your Formulary
Monthly Formulary Changes
Drug Usage Restrictions (QL, PA, ST)
Formulary Exceptions (Coverage Determinations)
Transition Fills
Coverage of Specific Drugs
Diabetes and Diabetic Coverage
The Donut Hole or Coverage Gap
Entering the Donut Hole
Donut Hole Discounts
Closing the Coverage Gap
Exiting the Donut Hole
Catastrophic Coverage
TrOOP and MOOP: Out of Pocket Costs
Specific Healthcare Coverage
Medicare Plan Providers
Traveling with Your Medicare plan
Moving and Medicare Part D
Drug Discount Cards
Using Part D with Other Drug Programs
VA and TRICARE Coverage
Employer Drug Coverage
General Medicare
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Medicare Part B
Medicare Set Aside Arrangements
Medicare and the ACA Marketplace
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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.