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Questions & Answers (FAQ)

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

Category: Living with your Medicare Part D plan

Back To FAQ Home Browse All (86) FAQs in Category

Most Viewed FAQs in Category


I wish to cancel my Medicare Part D prescription drug plan coverage. What should I do?
In most cases, you can only disenroll or cancel your Medicare Part D plan or Medicare Advantage plan during the Annual Enrollment Period (AEP) or annual Open Enrollment Period (OEP) which runs from ...

What is the BIN, PCN, and GROUP for my WellCare Medicare Part D prescription drug plan?
You can use your prescription drug plan even without having your Member ID card.  There are four numbers that your pharmacist needs to use your WellCare Medicare Part D prescription drug plan -...

Does Medicare Part D pay for the shingles vaccine?
Zostavax was approved in May 2006 by the U.S. Food and Drug Administration (FDA) as a vaccine for use in adults ages 60 and over who have had chickenpox.  Zostavax is covered under most Medicare ...

How do I get a prior authorization form for Humana?
Humana has now moved to an online form for prior authorization. Here is a link to the Humana online prior authorization form: https://humana.promptpa.com/ ...

How do I contact Humana about my Medicare Part D plan?
You can telephone Humana New Member Services at:1-888-839-7316 or Humana Customer Service at:1-800-457-4708.orHumana Enrollment & Information Center at: 1-800-833-6578or Humana Billing Depart...

How do I find out if my Humana Medicare Part D plan is active?
Just enrolled in a Humana prescription drug plan?  Here are some steps that may help you use your new Medicare Part D plan - while you are waiting for your Humana Member ID card to arrive in the ...

How can I change my Humana payment option?
The Enrollment & Billing telephone number for Humana is 1-800-992-2551.In addition, you may be able to change your payment option once you have create an online access account on www.humana.com.In...

What exactly is TrOOP or True Out of Pocket costs?
The Centers for Medicare and Medicaid Services (CMS) explain that,"True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold&...

I need the Humana form to order prescriptions by mail.
You may have received mail order information included with your Humana Member Welcome Packet. Humana mail order is focused on three companies:   RightSource (1-800-379-0092 )   ...

How can I check to see if my Aetna plan is active?
To check on the status of your enrollment at Aetna, you can call 1-800-282-5366, option 1.    Here is a second way to get your membership information.  On the internet go to www.a...

Newest FAQs in Category


How do I get a prior authorization form for Humana?
Humana has now moved to an online form for prior authorization. Here is a link to the Humana online prior authorization form: https://humana.promptpa.com/ ...

Does my Medicare Part D plan or Medicare Advantage plan also provide Silver Sneakers coverage?
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 Advantage ...

I cannot find a phone number for contact purposes regarding a claim denial.
Your first step would be to call the member services telephone number on the back of your membership card to speak with someone about your claim. If you have already done that and are looking for ...

I am being charged list price for my generics. I don't understand why.
Without more detailed information, I can think of only a few reasons why you would be paying list price for your generics. You could be in the deductible phase of your Medicare Part D cover...

Why is xanex or alprazolam not included in the drug formulary list? Some people had the need for the drug and you have a lot stronger drugs that are included. What is the reasoning on this?
You are correct, neither Xanax nor Alprazolam are covered under the Medicare Part D program. However, on the Medicare website, I found that both the First Health Part D Premier and the Aetna Medicare ...

When I am in my Medicare Part D plan's Donut Hole or Coverage Gap, how much do I actually pay? I have already reached my 2012 Medicare Part D prescription drug plan's initial coverage limit of $2930. So what do I pay?
Is the amount I owe in the Donut Hole the difference between the $4,700 out of pocket limit and the $2,930 initial coverage limit (or $1770) or do I have to pay the entire $4,700? Unfortunaley, we...

My husband has already reached the "donut hole" this year. Beginning January 1, 2012 will his coverage start over and he will be out of the "donut hole" or will he continue to be in the "donut hole" in 2012 until the $4700 out of pocket is satisfied?
On January 1, 2012, your husband's plan will start over.  If his plan has an initial deductible, he will need to pay the initial deductible again, otherwise he will be right in the init...

Although I understand that brand name drugs will be discounted 50% in the donut hole in 2011, my Medicare Part D plan’s monthly summary still shows that I will be responsible for 100% in what they term stage 2. Is this an error?
Complete Question: Although I understand that brand name drugs will be discounted 50% in the donut hole in 2011, my Medicare Part D plan’s monthly summary still shows that I will be responsible ...

I wanted to purchase a few medications without using my Medicare Part D plan and my local pharmacy said that I had to use my Medicare Part D card when purchasing my prescriptions. The pharmacy said it was illegal not to use my Medicare Part D plan.
Complete Question:  I wanted to purchase a few medications without using my Medicare Part D plan (my medications are not too expensive and I just wanted to see the actual retail drug prices) and ...

How much do I have to pay for generics in the donut hole in 2011, 2012, 2013,2014, 2015, etc. until it reaches 25%
Even if your Medicare Part D plan has no coverage in the gap, starting in 2011, you receive a discount on your medications while in the coverage gap. For generic drugs, you would pay the following p...


Back To FAQ Home Browse All (86) 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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