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FAQs on Choosing a Medicare Plan



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Category: Choosing a Medicare Plan


Most Viewed FAQs in Category
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 . . .

What is the Initial Coverage Limit? Can the limit vary between Medicare Part D plan providers?
Your Initial Coverage Limit (or ICL) is the boundary between your Medicare Part D plan's Initial Coverage Phase and the Donut Hole or Coverage Gap.  The ICL is the total retail value of formulary . . .

When selecting a Medicare Part D plan, should I just choose the plan with the lowest monthly premium?
No.  You need to look beyond just the monthly premium cost.  The "best" Medicare Part D prescription drug or Medicare Advantage plan for you is the plan that provides the most affordable hea . . .

If I enroll in a Medicare prescription drug plan that has an initial deductible, will the deductible impact when I go into the Donut Hole?
No.  Your Medicare Part D plan's Initial Deductible does not affect when you go into the Donut Hole or Coverage Gap.  However, your Initial Deductible will impact how quickly you exit the Do . . .

What do the Medicare plan ratings measure?
Medicare Health Plans (Medicare Advantage) For Medicare Advantage plans (MAs) covering health services (Medicare Part A and Medicare Part B), the overall score for quality of those services covers . . .

What is Coinsurance for the Medicare Part D Plans?
Coinsurance, according to the Centers for Medicare and Medicaid (CMS) is defined as: The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Pl . . .

What will my drugs cost in the donut hole? Negotiated price of insurer or retail price? How can I find out my cost of drugs in the donut hole?
You would pay your Medicare Part D plan's negotiated retail price, less the Donut Hole Discount.You can see an estimate of the cost of your medication during all phase of coverage on a particular Medi . . .

Can anyone join a Medicare Advantage plan?
Not exactly.  A person must meet a few conditions to be eligible to enroll in a Medicare Advantage plan. If you wish to enroll in a Medicare Advantage plan with (MAPD) or a Medicare Advantage . . .

What is the meaning behind Cobrands or Cobranding Medicare Part D Plans?
The  Cobrand  or Cobranding, according to the Centers for Medicare and Medicaid (CMS) is defined as: Refers to the partner relationships established between Medicare Prescription Drug Plans . . .

I am trying to select a new Medicare Part D Plan and I need help! How do you choose a Medicare Part D plan?
This question is being asked by almost everyone who is faced, either for the first time or once again, with evaluating their prescription drug needs and their Medicare Part D plan. The most afforda . . .

Newest FAQs in Category
What is the Initial Coverage Limit? Can the limit vary between Medicare Part D plan providers?
Your Initial Coverage Limit (or ICL) is the boundary between your Medicare Part D plan's Initial Coverage Phase and the Donut Hole or Coverage Gap.  The ICL is the total retail value of formulary . . .

If I enroll in a Medicare prescription drug plan that has an initial deductible, will the deductible impact when I go into the Donut Hole?
No.  Your Medicare Part D plan's Initial Deductible does not affect when you go into the Donut Hole or Coverage Gap.  However, your Initial Deductible will impact how quickly you exit the Do . . .

This year I am submitting a Medicare plan enrollment form, what are the most common enrollment errors that I can avoid?
Unfortunately, many people enrolling in a Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan make mistakes when submitting a printed enrollment forms.  The good news is that . . .

How do I find out whether my Medicare drug plan has a low-costing Tier One or Two medication that would substitute for my Tier Three prescription?
You and/or your prescriber can use our online Formulary Browser (https://FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-c . . .

Do you have email addresses for the Medicare Part D and Medicare Advantage plans?
When available, we provide email addresses for many Medicare Advantage plans (MAPDs, MAs, and SNPs).Unfortunately, we do not have email addresses for stand-alone Medicare Part D prescription drug only . . .

What will my drugs cost in the donut hole? Negotiated price of insurer or retail price? How can I find out my cost of drugs in the donut hole?
You would pay your Medicare Part D plan's negotiated retail price, less the Donut Hole Discount.You can see an estimate of the cost of your medication during all phase of coverage on a particular Medi . . .

Can I have a medicare supplement plus a Medicare Part D plan and what would the premium cost?
Yes, you can have a Medicare Supplement and a Medicare Part D prescription drug plan (PDP).  The monthly premium for your Medicare Part D plan would depend on your state and the plan you select.& . . .

Last year, I had really high medical and prescription costs. Can my current Medicare plan deny me coverage next year?
Generally speaking, No.  Medicare Part D prescription drug plans and Medicare Advantage plans are “guaranteed issue” to all people living within the plan’s service area - with . . .

Where can I find the Medicare Part D prescription drug plan formularies or drug lists?
Our Q1Medicare.com Formulary Browser includes formularies for all Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAPDs).  Our Formulary Browser is easy to use and is . . .

What is Co-Insurance?
Co-Insurance is a type of cost-sharing that refers to the payment of a percentage of the medication's negotiated retail drug cost that you would pay for a medication assigned to a logical grouping or . . .






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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.