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Questions & Answers (FAQ)
The categories of Frequently Asked Questions (FAQs) can be found to the right. Simply click on one of the questions below or a category to the right.
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$250 Doughnut Hole Rebate
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I read that the retail drug costs go toward the $2830 before reaching the donut hole. My Part D plan told me that the costs are the amount paid by my Part D insurance plus my out-of-pocket co-pay. For example, I take a drug that has a retail cost of $49.99 for a 30 day supply. But on my statement, my Part D plan paid $7.93 and I paid a $5 co-pay, which means that I have only earned $12.93 toward the 2010 donut hole. So which is correct-the $49.99 or $12.93 when calculating how much I've spent toward the donut hole?
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I received my Part D plan statement and my out of pocket costs are over $700. The total amount of my drug costs are over $2,450 and I will soon reach the $2,830. Do I need to have out of pocket costs or TrOOP reaching $4,550.00 before I'm paid more?
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I reached the Donut Hole in 2009 when enrolled in my Medicare Part D Prescription Drug Plan. Am I eligible for the $250 rebate recently announced by Medicare?
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If I am getting Medicare and Social Security, am I still eligible for the rebate?
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I do not belong to a Medicare Part D plan and actually pay for all of my own prescription drugs. Will I also get the $250 donut hole rebate payment?
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Who will send me my check my Medicare Part D plan or Medicare?
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Is the $250 rebate a one-time payment or will I be paid $250 for each month that I am in the donut hole?
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What exactly is the 2010 Medicare Part D $250 Coverage Gap Rebate?
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Who Gets the $250 Rebate?
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Will I still receive the $250 rebate if I am in a Medicare Advantage plan that provides prescription drug coverage (an MA-PD)?
Closing the Coverage Gap
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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 talked directly with Medicare and they said I will still have the same out of pocket requirements, i.e. it'll just essentially take me twice as long. Can you clarify?
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My current prescription drug retail cost are $230 per month. What will be my discount in the Doughnut Hole?
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Can you provide an example of the 2011 Donut Hole Discount?
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Will monthly Medicare Part D premiums increase due to the manufacturer’s discount on brand-name drugs purchased in the Coverage Gap?
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I have a PACE plan, will I get the discount on brand-name drugs purchased in the Coverage Gap?
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Does everyone receive a discount in the Coverage Gap?
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Which brand name prescription drugs are eligible for the 2011 Coverage Gap or Donut Hole discount?
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Will the Coverage Gap discount program affect which brand drugs are offered under Medicare Part D?
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Who is really paying for the discount on drugs purchased in the Coverage Gap?
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If I go into the 2011 Coverage Gap, will my Doughnut Hole discount be deducted at the pharmacy or will I get a refund from my Part D plan?
General Medicare Part D
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What is meant by the abbreviations: EA BA DS AE in the plan benefit type?
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Medicare Part D? What is it? How do I do to get it? Who pays for it? How do I enroll?
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What are the United States territories that are also covered by Medicare Part D prescription drug plans? What Medicare Part D plans will offer coverage in these area during 2009?
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Where can I get a Medical Power of Attorney form?
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What is Public Law No: 110-275 - Medicare Improvements for Patients and Providers Act of 2008 or MIPPA?
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What are the CMS Medicare Part D prescription drug plan regions?
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How many companies will be offering a Medicare Part D prescription drug plans on a national basis?
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Do people who sell Medicare drug plans have to be licensed insurance agents?
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Will the drugs covered by Medicare drug plans meet the needs of both seniors and people with disabilities?
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What is Medicare Prescription Drug Coverage?
Before Enrolling in a Medicare Prescription Drug Plan
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Who actually calculates the amount of my late-enrollment penalty?
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If I enroll in a Medicare prescription drug plan that has an initial deductible, will it have any impact on when I go into, or out, of the Doughnut Hole or Coverage Gap?
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I would like to enroll in a Cigna Medicare Part D prescription drug plan or Cigna Medicare Rx plan. Is there a pre-enrollment disclaimer that I can review before enrolling?
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Medicare Part D? What is it? How do I do to get it? Who pays for it? How do I enroll?
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What is the Initial Coverage Limit or drug cost ceiling before going into the donut hole or coverage gap? The limit seems to vary between Medicare Part D plan providers.
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Does prescription drug coverage under a Medigap (or Medicare Supplement) plan H, I or J qualify as “creditable coverage” for purposes of avoiding the Medicare Part D late enrollment premium penalty?
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Where can I get a Medical Power of Attorney form?
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What do I need to know if I have drug coverage from TRICARE, the Department of Veteran's Affairs (VA), or the Federal Employee Health Benefits Program (FEHB)?
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Will my drugs be covered?
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Should I join a Medicare drug plan even if I don't take many prescription drugs?
Medicare Part D Enrollment
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I would like to enroll in a Cigna Medicare Part D prescription drug plan or Cigna Medicare Rx plan. Is there a pre-enrollment disclaimer that I can review before enrolling?
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I am enrolling in a new Medicare Part D plan for next year. I still have enough of a 90 day prescription left from my old company plan to last me until February. Can I make my part D plan effective beginning February 1 to save the cost of the January Part D premium?
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Do any companies offer a non deductible and no pay in the donut hole? In the beginning of he Part D program they did for a higher premium then it was stopped.
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I just selected a Medicare Part D plan and now the CMS Part D plan ratings are online. Are the Plan ratings really important?
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Last year, my Part D prescription drug coverage was delayed because of a problem with my enrollment application. How can I avoid this problem this year?
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I didn’t enroll in a Medicare Part D plan when I was first eligible, how will I calculate my Part D premium penalty?
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I noticed that there are many different ways to pay our monthly Medicare Part D premiums. Is there one way to pay that is better than the others?
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Should I send a monthly payment in with my Medicare Part D enrollment form?
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What is the Initial Coverage Limit or drug cost ceiling before going into the donut hole or coverage gap? The limit seems to vary between Medicare Part D plan providers.
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I enrolled in a new Medicare Part D plan during the Annual Election Period, then, after speaking with some other people, I changed my mind and enrolled in another Part D plan. What happened if I enrolled in multiple Medicare Part D plans?
Living with your Medicare Plan
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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 talked directly with Medicare and they said I will still have the same out of pocket requirements, i.e. it'll just essentially take me twice as long. Can you clarify?
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What should I do now that I am in the Donut Hole or Coverage Gap? Is there any way to save money or are there programs available to help people like me pay for my prescription drugs?
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What happens when we buy our prescriptions or medications in advance? For instance, what occurs if we buy a three-month supply of medication through mail order does this have any effect on when we enter the doughnut hole or coverage gap?
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I am spending a lot of money on drugs and my Part D plan. What part of my spending is not counted toward my prescription drug plan's Donut Hole?
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You say that I will enter my Medicare Part D plan's Doughnut Hole or Coverage Gap when my retail drug costs reach a certain dollar level that changes every year. What exactly do you mean by "retail drug costs"? Is that what I spend on all my pharmacy drugs or something else?
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When does a Medicare Part D beneficiary enter and exit the doughnut hole or coverage gap? The Doughnut Hole calculators seem to provide an estimate. But how does a Medicare Part D beneficiary really know exactly when they enter and leave the coverage gap?
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Why is Fioricet with codeine covered under Medicare Part D but not plain Fioricet?
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How does the Maryland SPDAP $1,200 Coverage Gap Subsidy work?
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I purchased these test strips and had to pay for them even though they are part of my diabetic supplies. The pharmacist said Medicare would refund this money, but they never have. Should my Medicare Part D plan reimburse these supplies?
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How does the premium grace period work on Medicare Part D plans?
Changing Medicare Part D Plans
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How do you disenroll from a Cigna Medicare Rx plan or Medicare Part D prescription drug plan?
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Will I lose my original Medicare Part A and Part B coverage if I enroll in Medicare Advantage Plan?
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Why did the monthly premium of my Medicare prescription drug plan almost double?
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I want to switch plans for next year. Do I have to contact my old plan?
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How is a person's previous prescription drug spending (or True Out of Pocket costs - TrOOP) affected if a Medicare Part D beneficiary switches Medicare Part D prescription drug plans? In other words, if you move to another Part D plan, do you start again from the beginning of the Part D plan?
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If I am in the coverage gap and I move and have to switch part d plans, will I be in the coverage gap in the new plan or start all over?
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I wish to disenroll from my Medicare Part D coverage. What should I do?
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When and how often can I switch my Medicare drug plan?
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How soon will I get a refund of any premiums that are withheld for my current plan after I enroll in a new plan? Who will the refund come from?
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What happens if I change plans and request automatic premium deductions from my Social Security benefits for my new plan, but the premium deduction from my previous plan doesn't stop?
Medicaid & Extra Help & LIS
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Are there any Medicare Part D prescription drug plans that are free for Medicare beneficiaries over the financial limits for Medicaid and Extra Help?
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How do I search for a Medicare Part D plan that qualifies for the $0 premium Low-Income Subsidy?
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I have a relative who is getting SSD along with health coverage. His mother just passed away and he will receive a substantial amount of funds from the sale of her estate. Can this effect his health coverage?
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Is Lifeline (personal response system) a covered benefit under Medicare if there is a medical indication for it?
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How will people know if their copayment amounts will change?
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How does this affect people who currently automatically qualify for extra help?
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What efforts are underway affecting people who qualify for extra help paying for their Medicare prescription drug coverage?
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What if people don't agree with Social Security's decision on "extra help"?
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What should people do if they think there's been a mistake determining their eligibility for extra help?
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Will everyone with extra help get a letter from Medicare or Social Security?
Other Q1Medicare.com Questions
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How can I get a 2009 Medicare & You Handbook?
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I have a relative who is getting SSD along with health coverage. His mother just passed away and he will receive a substantial amount of funds from the sale of her estate. Can this effect his health coverage?
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Is Lifeline (personal response system) a covered benefit under Medicare if there is a medical indication for it?
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What are the Medicare premiums and coinsurance rates for 2008?
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Where can I get a Medical Power of Attorney form?
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I am asking you this question, because I do not know where or how to look up my question. I want to donate my body when I die, hoping it will help someone else. Can you please tell me a web site to go to.
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What do I do when a Medicare beneficiary dies?
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What if I have a prescription for a drug that isn't on my plan's list of covered drugs (formulary)?
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Do people who sell Medicare drug plans have to be licensed insurance agents?
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Can my doctor ask for an exception on my behalf?
Medicare Advantage Plans
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What are Coordinated Care Plans?
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Can we find more information about Medicare Advantage plans on the Q1Medicare.com site?
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Is a Medicare Advantage plan the best choice for most people?
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Are all Medicare Advantage Plans pretty much the same?
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I already have a Medicare Supplement Plan, can I also enroll in a Medicare Advantage Plan?
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If I am not happy in my Medicare Advantage plan, can I go back to my Original Medicare Part A and Part B or my old Medicare Supplement coverage?
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Are Medicare Advantage Plans the same as Medicare Supplements?
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What is a Health Maintenance Organization (HMO) Medicare Advantage Plan?
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Can anyone join a Medicare Advantage Plan?
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What is an HMO POS Medicare Advantage Plan?
Medicare Supplements
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I already have a Medicare Supplement Plan, can I also enroll in a Medicare Advantage Plan?
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If I am not happy in my Medicare Advantage plan, can I go back to my Original Medicare Part A and Part B or my old Medicare Supplement coverage?
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Are Medicare Advantage Plans the same as Medicare Supplements?
The Coverage Gap or Donut Hole or Doughnut Hole
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I read that the retail drug costs go toward the $2830 before reaching the donut hole. My Part D plan told me that the costs are the amount paid by my Part D insurance plus my out-of-pocket co-pay. For example, I take a drug that has a retail cost of $49.99 for a 30 day supply. But on my statement, my Part D plan paid $7.93 and I paid a $5 co-pay, which means that I have only earned $12.93 toward the 2010 donut hole. So which is correct-the $49.99 or $12.93 when calculating how much I've spent toward the donut hole?
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What should I do now that I am in the Donut Hole or Coverage Gap? Is there any way to save money or are there programs available to help people like me pay for my prescription drugs?
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If I have to pay 100% of my own drug costs when I go into the Doughnut Hole, why don’t I just stop paying my monthly Part D plan premiums?
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Can I avoid the Doughnut Hole if I buy a 90-day supply of my medications with the lower co-payment?
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I never got a report from my Part D plan showing how close I am to the Doughnut Hole. Shouldn’t I be getting a summary of my prescription drug spending?
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I think that I have already spent my way through this year’s Doughnut Hole. Is that possible?
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I purchased a Medicare Part D plan with coverage during the Doughnut Hole, so I guess I am protected throughout the year, right?
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How exactly does the Coverage Gap fit into my prescription drug plan?
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What costs do NOT count toward entering the Doughnut Hole?
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Will you enter the Doughnut Hole this year?
The Late-Enrollment Penalty
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Who actually calculates the amount of my late-enrollment penalty?
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I didn’t enroll in a Medicare Part D plan when I was first eligible, how will I calculate my Part D premium penalty?
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Does prescription drug coverage under a Medigap (or Medicare Supplement) plan H, I or J qualify as “creditable coverage” for purposes of avoiding the Medicare Part D late enrollment premium penalty?
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If I have a disability and receive Medicare benefits before reaching 65, can I also sign up for a Medicare Part D prescription drug plan at the same time? What if I decide NOT to join a Part D plan, do I pay a penalty if I decide to join a Part D plan later?
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I moved to a different state (in another Part D Region) where my original plan offers no coverage (it was a local plan in my former state). I am now forced to change Part D plans - how do I avoid a premium penalty increase with the new plan?
Q1Medicare.com Online Tool Tips
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What is Joppel?
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How does Joppel actually work?
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Can you provide an example of the 2011 Donut Hole Discount?
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Is there an online tool that shows me all of the prescription drugs covered by a specific Medicare Part D plan?
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Can we find more information about Medicare Advantage plans on the Q1Medicare.com site?
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What is the Q1Medicare PDP-Wizard?
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What is the tool that provides an estimate of the annual drug cost?
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How do I search for a Medicare Part D plan that qualifies for the $0 premium Low-Income Subsidy?
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What is the Q1Medicare PDP-Compare tool?
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What is the Q1Medicare PDP-Finder tool?
Joppel
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What is Joppel?
•
How does Joppel actually work?
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Browse by Category
$250 Doughnut Hole Rebate (24)
Closing the Coverage Gap (17)
General Medicare Part D (43)
Before Enrolling in a Medicare Prescription Drug Plan (54)
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Living with your Medicare Plan (91)
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Medicaid & Extra Help & LIS (31)
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Latest Added FAQs
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How does Joppel actually work?
Joppel is a decision assistance or support system designed for the Medicare community, their familie
. . .
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What is Joppel?
Joppel is a new online tool that helps the Medicare community make better Medicare plan decisions.Jo
. . .
•
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 talked directly with Medicare and they said I will still have the same out of pocket requirements, i.e. it'll just essentially take me twice as long. Can you clarify?
The Medicare representative is correct in saying that your requirement (out-of-pocket cost limit or
. . .
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My current prescription drug retail cost are $230 per month. What will be my discount in the Doughnut Hole?
If your total retail prescription medication costs are under $236, you will not exceed&nbs
. . .
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Can you provide an example of the 2011 Donut Hole Discount?
We have updated our 2011 PDP-Planner (or Donut Hole Calculator) to include the model plan featu
. . .
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