Frequently Asked Questions about Living with Your Medicare Part D Plan

You can drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the annual Open Enrollment Period - or a Special Enrollment Period - or you can be involuntarily disenrolled from your plan.

Your (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan - and these four n . . .

Please contact the Medicare prescription drug plan Member Services department (Medicare Part D or Medicare Advantage plan) directly to receive your replacement Member ID card.The toll-free number for . . .

You do not need to do anything.  If your Medicare Advantage plan or Medicare Part D prescription drug plan is offered next year - and you make no enrollment decision, you will be automatically . . .

The Centers for Medicare and Medicaid Services (CMS) have implemented safe-guards to protect Medicare beneficiaries who inadvertently missed a Medicare Part D premium payment and require Medicare p . . .

A few 2020 Medicare Advantage plans cover both Fioricet with Codeine and Fioricet without Codeine, however no stand-alone Medicare Part D plans cover Fioricet with or without Codeine. For example, . . .

First, you can contact your chosen Medicare plan's Member Services department and check that your address was entered correctly and that your Member ID card (and plan information) was sent.  Whil . . .

You are correct in your assumption that Clonazepam is not covered by your Medicare Part D plans Clonazepam is not covered by any Medicare Part D plan. By design, certain classes of medication we . . .

Yes, "when [these medications are] used to treat epilepsy, cancer, or a chronic mental health disorder". A certain group of prescription medications are specifically excluded from Medicare Part D p . . .

Your stand-alone Medicare Part D prescription drug plan (PDP) only provides coverage for your prescription medications and probably does not include a fitness benefit. However, many Medicare Advant . . .

Complete Question: For 2011 you indicate that the full retail cost of drugs while in the donut hole will apply to the amount required to get out for name brands even though I'm only paying 50%. I talk . . .

Unfortunately, we cannot provide a direct answer to that question. Medicare Part D Drug Plans can change their premiums every year and some Part D premiums have gone up every year - as in your case, a . . .

Yes.  As noted by the Centers for Medicare and Medicaid Services (CMS), a Medicare Part D or Medicare Advantage plan can disenroll a plan member for non-payment of premiums after proper notice an . . .

No. The Medicare Part D program is voluntary and, like any insurance-type program, you can choose to not use your prescription drug plan and pay your prescription costs out of your own pocket - althou . . .

The Maryland Senior Prescription Drug Assistance Program (SPDAP) Coverage Gap Subsidy works as follows: Once you reach the Coverage Gap, you would still go to your same pharmacy and purchase your p . . .

Your question is one that many people are also asking. In theory, if you drop Medicare Part D coverage, you will pay an increased premium based on each month that you are without Medicare Part D cover . . .

On January 1st, your Medicare Part D plan will start over - and you will no longer be in the Coverage Gap. If your Medicare Part D plan has an Initial Deductible, you will need to pay the initial d . . .

If you have a prescription for a drug that isn't on your plan's formulary, you should ask your doctor if there is another drug you can take that is on your plan's formulary.  If your doctor can't . . .

No.  You are not required to use your Medicare Part D plan even when you are buying a formulary drug at one of your Medicare plan's network pharmacies. However, except in certain situations (e . . .

Yes, your doctor can request an exception (or any other type of coverage determination) on your behalf.  In cases where delays may seriously affect your health, your doctor can also ask for an ex . . .

No.  You are not required to use your Medicare Part D plan even when you are buying a formulary drug at one of your Medicare plan's network pharmacies. However, except in certain situations (e . . .

If you have recently enrolled in a Medicare plan and still have not received your new Medicare Part D or Medicare Advantage plan Member ID card, please contact your Medicare plan’s Member Serv . . .

Your new Medicare Part D plan year will begin on January 1st of each year.The Medicare Part D plan year runs from January 1st through December 31st of each year, so the plan year runs for a calendar y . . .

Your stand-alone Medicare Part D prescription drug plan (PDP) only provides coverage for your prescription medications and probably does not include a fitness benefit. However, many Medicare Advant . . .

Your first step would be to call the Member Services telephone number on the back of your Membership ID card to speak with someone about your claim. If you have already done that and are looking f . . .

Yes, "when [these medications are] used to treat epilepsy, cancer, or a chronic mental health disorder". A certain group of prescription medications are specifically excluded from Medicare Part D p . . .

On January 1st, your Medicare Part D plan will start over - and you will no longer be in the Coverage Gap. If your Medicare Part D plan has an Initial Deductible, you will need to pay the initial d . . .

No. The Medicare Part D program is voluntary and, like any insurance-type program, you can choose to not use your prescription drug plan and pay your prescription costs out of your own pocket - althou . . .

Complete Question: For 2011 you indicate that the full retail cost of drugs while in the donut hole will apply to the amount required to get out for name brands even though I'm only paying 50%. I talk . . .

The Maryland Senior Prescription Drug Assistance Program (SPDAP) Coverage Gap Subsidy works as follows: Once you reach the Coverage Gap, you would still go to your same pharmacy and purchase your p . . .

A few 2020 Medicare Advantage plans cover both Fioricet with Codeine and Fioricet without Codeine, however no stand-alone Medicare Part D plans cover Fioricet with or without Codeine. For example, . . .

Yes.  As noted by the Centers for Medicare and Medicaid Services (CMS), a Medicare Part D or Medicare Advantage plan can disenroll a plan member for non-payment of premiums after proper notice an . . .

The Centers for Medicare and Medicaid Services (CMS) have implemented safe-guards to protect Medicare beneficiaries who inadvertently missed a Medicare Part D premium payment and require Medicare p . . .

The only way to file a complaint with Medicare is by calling 1-800-633-4227. You will need to have the beneficiary's Medicare claim number, date of birth, name and effective date f . . .

Unfortunately, we cannot provide a direct answer to that question. Medicare Part D Drug Plans can change their premiums every year and some Part D premiums have gone up every year - as in your case, a . . .

Medicare Part D plan provides usually send out a periodic "Explanation of Benefits" letter to all of their members.Often some of the larger pharmacies also provide a summary of your Part D p . . .

You do not need to do anything.  If your Medicare Advantage plan or Medicare Part D prescription drug plan is offered next year - and you make no enrollment decision, you will be automatically . . .

Your (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan - and these four n . . .

You can drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the annual Open Enrollment Period - or a Special Enrollment Period - or you can be involuntarily disenrolled from your plan.

Premium deductions generally start two months after your Medicare drug plan submits the request. It can take longer if there are problems with the request. Social Security will keep track of the numbe . . .