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FAQs on General Medicare Part D



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

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Category: General Medicare Part D

Back To FAQ Home . Browse All (28) FAQs in Category

Most Viewed FAQs in Category


What is meant by the abbreviations: EA BA DS AE in the plan benefit type?
The Medicare Part D Benefit Types as shown in PDP-Facts our Part D Plan Statistics (National and State) are defined by CMS as follows:Per the 2010 CMS Call Letter: "In establishing the Part D pr...

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 Step Therapy in Medicare Part D?
Step Therapy is a utilization management restriction that a Medicare Part D prescription drug plan can add to a prescription medication.  On our Medicare prescription drug finder (www.Q1Rx.com), ...

What is a Medicare Medical Savings Account (MSA) Plan?
A  Medicare Medical Savings Account (MSA) Plan, according to the Centers for Medicare and Medicaid (CMS) is defined as: A type of Medicare Advantage Plan.Medical Savings Account (MSA) Plans have...

What is a Medicare Advantage Special Needs Plan (SNP) and can anyone join a SNP?
Not everyone can join a SNP.  Usually anyone can join a Medicare Advantage plan that lives within the plan's service area, has Medicare Parts A & B and does not suffer from End-Stage Rendal D...

What are the CMS Medicare Part D prescription drug plan regions?
The Medicare Modernization Act mandated that the Centers for Medicare and Medicaid Services (CMS) establish geographic regions for the implementation of the Medicare Part D prescription drug plans (PD...

What is Public Law No: 110-275 - Medicare Improvements for Patients and Providers Act of 2008 or MIPPA?
The  Medicare Improvements for Patients and Providers Act of 2008 or MIPPA was passed in July 2008 and amends a number of sections of the existing Medicare law or, in the words of Congress, the M...

What are the United States territories that are also covered by Medicare Part D prescription drug plans? Is there a way to see the Medicare Part D plans offered in these U.S. Territories?
There are five United States territories that are covered by the Medicare Part D program and offer stand-alone Medicare Part D prescription drug plans: American Samoa Guam the North...

What are Tiers in Medicare Part D?
 Tiers, according to the Centers for Medicare and Medicaid (CMS)are defined as: Drugs on a formulary are often organized into different drug “tiers,” or groups of different drug type...

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 companies. They are part ...

. Newest FAQs in Category


What is meant by the abbreviations: EA BA DS AE in the plan benefit type?
The Medicare Part D Benefit Types as shown in PDP-Facts our Part D Plan Statistics (National and State) are defined by CMS as follows:Per the 2010 CMS Call Letter: "In establishing the Part D pr...

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...

How can I get financial "extra help" with my medication or Medicare Part D prescription drug costs?
To apply for the Medicare Part D Extra Help program you can:telephone the Social Security Administration (1-800-772-1213)  between 7 a.m. and 7 p.m., Monday through Friday; (TTY/TDD users should...

What are the United States territories that are also covered by Medicare Part D prescription drug plans? Is there a way to see the Medicare Part D plans offered in these U.S. Territories?
There are five United States territories that are covered by the Medicare Part D program and offer stand-alone Medicare Part D prescription drug plans: American Samoa Guam the North...

What is Public Law No: 110-275 - Medicare Improvements for Patients and Providers Act of 2008 or MIPPA?
The  Medicare Improvements for Patients and Providers Act of 2008 or MIPPA was passed in July 2008 and amends a number of sections of the existing Medicare law or, in the words of Congress, the M...

What are the CMS Medicare Part D prescription drug plan regions?
The Medicare Modernization Act mandated that the Centers for Medicare and Medicaid Services (CMS) establish geographic regions for the implementation of the Medicare Part D prescription drug plans (PD...

What is the Monthly Premium in Medicare Part D?
The  Monthly Premium, according to the Centers for Medicare and Medicaid (CMS) is defined as: The periodic payment to Medicare, an insurance company, or a health care plan for health care or pre...

Will the drugs covered by Medicare drug plans meet the needs of both seniors and people with disabilities?
Yes. Medicare drug plans must cover drugs and/or categories of drugs that are commonly used by seniors and people with disabilities.(Source: U.S. Department of Health & Human Services)...

What is Cost Sharing in Medicare Part D?
Cost Sharing , according to the Centers for Medicare and Medicaid (CMS) is defined as: The amount you pay for health care and/or prescriptions. This amount can include copayments, coinsurance, and/or...

What is the Deductible in the Medicare Part D Plans?
The Deductible, according to the Centers for Medicare and Medicaid (CMS) is defined as: The amount you must pay for health care or prescriptions, before the Medicare drug plan begins to pay. The...


Back To FAQ Home . Browse All (28) FAQs in Category




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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.
  • 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.


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