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Browse the Medicare Part D "Where do I start?" FAQs
If you still have questions, please contact us through our Online Help Desk.

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Category: Where do I start?

Back To FAQ Home . Browse All (14) FAQs in Category

Most Viewed FAQs in Category


I am new to Medicare. Where can I get an overview of the Medicare Part D program?
In general, Medicare Part D prescription drug plans provide insurance coverage for your prescription drugs - and work just like other types of insurance, you usually pay a monthly premium, you may pay...

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)...

Is there really any difference between a Medicare Part D prescription drug plan and a Medicare Advantage plan?
Yes!  A stand-alone Medicare Part D prescription drug plan (or PDP) only provides out-patient prescription drug coverage. Alternatively, Medicare Advantage plans provide coverage 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...

Medicare Part D? What is it? How do I do to get it? Who pays for it? How do I enroll?
The Medicare Part D prescription drug program provides prescription drug coverage through either stand-alone Medicare prescription drug plan (PDPs) or Medicare Advantage plans that include prescriptio...

What is a Medicare Advantage Plan?
A Medicare Advantage Plan, according to the Centers for Medicare and Medicaid (CMS) is defined as: Health plan options that are approved by Medicare but run by private insurance companies. Medicare A...

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 affordabl...

What is Medicare Part B coverage?
Medicare Part B (out-patient medical insurance), according to the Centers for Medicare and Medicaid (CMS) is defined as: Medicare medical insurance that helps pay for doctors' services, outpatient ho...

What is Medicare Part A (Hospital Insurance)?
Medicare Part A (In-patient or Hospital Insurance), according to the Centers for Medicare and Medicaid (CMS) is defined as: Medicare Part A is the part of Medicare that pays for inpatient hospital st...

How does this work? I see now that I have to choose a plan. Does SS take money out of my account for this? What is the cost of the plans? Are you charged whether you use it or not?
Lets see if we can get some of your questions answered. It is your choice if your monthly premium is deducted from your social security check or your checking account, etc.  You...

. 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...

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 is the Q1Medicare PDP-Finder Medicare Part D prescription drug finder and how can I use this tool?
Our Medicare Part D prescription drug plan finder or PDP-Finder tool was designed to provides basic information on all stand-alone Medicare Part D plans in all states and Unites States territories. ...

Already enrolled? What to do while waiting for your new Medicare Part D prescription drug plan Member ID card.
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...

Is there really any difference between a Medicare Part D prescription drug plan and a Medicare Advantage plan?
Yes!  A stand-alone Medicare Part D prescription drug plan (or PDP) only provides out-patient prescription drug coverage. Alternatively, Medicare Advantage plans provide coverage for your...

I am new to Medicare. Where can I get an overview of the Medicare Part D program?
In general, Medicare Part D prescription drug plans provide insurance coverage for your prescription drugs - and work just like other types of insurance, you usually pay a monthly premium, you may pay...

What is Medicare Part D cost-sharing?
Cost-sharing refers to the portion of your Medicare Part D plan coverage or Medicare Advantage plan coverage that you pay (such as $30 to fill a brand name prescription or $20 to visit a doctor).Like ...

How does this work? I see now that I have to choose a plan. Does SS take money out of my account for this? What is the cost of the plans? Are you charged whether you use it or not?
Lets see if we can get some of your questions answered. It is your choice if your monthly premium is deducted from your social security check or your checking account, etc.  You...

What is a Medicare PDP and an MAPD?
A PDP is the abbreviation for a "prescription drug plan" and an MAPD is an abbreviation for a "Medicare Advantage plan that offers prescription drug coverage"  If you need drug coverage, and are ...

What is Medicare Part A (Hospital Insurance)?
Medicare Part A (In-patient or Hospital Insurance), according to the Centers for Medicare and Medicaid (CMS) is defined as: Medicare Part A is the part of Medicare that pays for inpatient hospital st...


Back To FAQ Home . Browse All (14) FAQs in Category




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Browse Categories
Q&A of the Day
Where do I start?
General Medicare Part D
Medicare Advantage plans (MAPD)
Medicare Supplements or Medigap
Choosing a Medicare plan
Medicare plan Star Ratings
Medicare Part D Enrollment
ANOC: Annual Plan Changes
Switching Medicare Part D plans
Medicare Enrollment Periods
Special Enrollment Periods (or SEPs)
Medicare plan Disenrollment
The Late-Enrollment Penalty
Paying Your Premiums
Medicaid & Extra Help & LIS
IRMAA: Higher Incomes and Costs
Living with your Medicare Part D plan
Explanation of Benefits (EOB)
Pharmacies and Part D
Specific Healthcare Coverage
Medicare plan Providers
Retail Drug Pricing
Straddle Claims
Understanding your Formulary
Monthly Formulary Changes
Drug Usage Restrictions
Formulary Exceptions
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
Out of Pocket Costs: TrOOP and MOOP
Traveling with your Medicare plan
Moving and Medicare Part D
Using Part D with other Drug programs
VA and TRICARE Coverage
Employer Drug Coverage
Medicare Savings Account (MSA) plans
General Medicare
Medicare Part B
Medicare Set Aside Arrangements
Medicare and the ACA Marketplace
Q1Medicare.com Online Tool Tips
Other Q1Medicare Tips and Questions
$250 Doughnut Hole Rebate (only in 2010)


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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.