Q1Medicare.com
Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • ☰ MENU
  • Home
  • Contact
  • MAPD
  • PDP
  • 2017
  • FAQs
  • Latest Medicare News

Am I allowed to use a Drug Discount Program instead of my Medicare Part D plan?



Browse the Medicare Part D "Retail Drug Pricing" FAQs
If you still have questions, please contact us through our Online Help Desk.


Back To FAQ Home FAQ 7 of 12 in this Category Prev   Next


Question: Am I allowed to use a Drug Discount Program instead of my Medicare Part D plan?

Answer: Yes.  Medicare Part D prescription drug coverage is voluntary and, if you find a cheaper place to purchase medications, then you are permitted buy your medications without using your Medicare Part D prescription drug plan.

However, there are a few things to consider when purchasing your medications outside of your Medicare Part D plan that include:
  • As always, please calculate your savings when using a drug discount program. You may be paying more for your medications with a drug discount card than with your Medicare Part D plan coverage. Some drug discount plans mention an average savings of 24%.  However, the standard Medicare Part D plan design offers medications at 25% of the retail price. Also if you have high monthly retail drugs costs (for example, you buy drugs with an average monthly retail value of over $309 in 2017) you will reach your 2017 Medicare plan's Coverage Gap and may be able to take advantage of the Donut Hole discounts where you will receive a 60% discount on brand name drugs and a 49% discount on generic medications.  (The Donut Hole discount will continue to increase until 2020 when Donut Hole drug purchases will receive a 75% discount - meaning you only pay 25% of retail).
  • If you purchase medications with a discount card and do not submit your receipts, your Medicare Part D plan does not have a record of your drug purchases, and you will not have the added safety feature of your Medicare Part D plan’s drug usage monitoring.
  • If you are in your Medicare Part D Initial Deductible and/or Coverage Gap, and purchase medications using a discount card, you may be able to submit your discounted formulary drug purchase receipts to your Medicare Part D plan so the drug costs will be included in your out of pocket expenses (TrOOP). You can only get credit for formulary drug purchases made at network pharmacies and during the Initial Deductible or Coverage Gap when you are 100% responsible for your drug costs. Please contact your Medicare Part D plan to learn more and confirm that you can submit copies of your receipts.  You can read more in our FAQ on the Lower Cash Price policy.
  • If you try to save more money and stop paying your Medicare Part D premiums in an effort to leave your Medicare Part D plan, and do not have any other form of creditable prescription drug coverage (VA, TRICARE, Employer coverage), you will be subject to the permanent late-enrollment premium penalty should you ever decide to re-enroll in a Medicare prescription drug plan.
  • If your 2017 average monthly retail drug costs are more than $309 but less than $672, you will enter the 2017 Coverage Gap, but may not have high enough out-of-pocket drug spending exit the Coverage Gap and enter your Medicare Part D plan’s Catastrophic Coverage phase (where you can receive a 95% discount on the retail cost of your medications).  In this case, you can consider using a drug discount program for purchases made in the Donut Hole, if they are significantly less expensive than your cost using the Donut Hole discount.
  • As an alternative to a discount program, you can seek out retail pharmacies with everyday or “usual and customary” low retail drug prices. Purchases from retailers with everyday low drug prices are not considered a one-time discount or a discount program, so your Medicare Part D coverage can be used together with the pharmacy's every-day low drug price. You can click here to learn more about network pharmacies with lower, everyday retail prices.



Back To FAQ Home FAQ 7 of 12 in this Category Prev   Next




Click the +1 button if you have found this page useful:  

Advertisement
Medicare Supplements
fill the gaps in your
Original Medicare
1. Select Your State:
» Medicare Supplement FAQs

Advertisement


Browse Categories
Q&A of the Day
Help! Where do I start?
General Medicare Part D
Medicare Advantage plans (MAPD)
Medicare Supplements or Medigap
Choosing a Medicare plan
Star Ratings & Medicare plan quality
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
Drug Discount Cards
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)


.

Advertisement



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.