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Questions & Answers (FAQ)

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Home > Living with your Medicare Part D Plan

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87 questions found in  'Living with your Medicare Part D Plan'
Showing 1-20 of 87 Next

Question: I am being charged list price for my generics. I don't understand why.
Answer: 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...

Question: I cannot find a phone number for contact purposes regarding a claim denial.

Answer: 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 ...

Question: 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?

Answer: 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 ...

Question: 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?
Answer: 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...

Question: 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?
Answer: 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...

Question: 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%. Can you clarify?
Answer: Complete Question: 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 talk...

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 for 100% in what they term stage 2. Is this an error?
Answer: 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 ...

Question: 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.
Answer: 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 ...

Question: How much do I have to pay for generics in the donut hole in 2011, 2012, 2013,2014, 2015, etc. until it reaches 25%
Answer: 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...

Question: How do I know when I will reach my Medicare Part D plan's Donut Hole or Coverage Gap?
Answer: There are multiple ways to see how close you are to your Donut Hole.  Here are a few examples of how you can tell when you have reached your Medicare Part D plan's Doughnut Hole (or Coverage Gap)...

Question: 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?
Answer: Unfortunately, if you are in the coverage gap - and your Medicare Part D prescription drug plan does not provide any donut hole coverage (for instance, generic drug coverage), then there are only...

Question: 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?
Answer: Yes, the timing of your prescription drug purchases can affect when you go into the Doughnut Hole.The Coverage Gap or Doughnut Hole arrives at different times for each person depending their  tot...

Question: 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?
Answer: As you know, only the retail price of formulary drugs purchased with your Part D plan are counted toward your entry into the Coverage Gap or Doughnut Hole.There are a number of Medicare Part D plan co...

Question: 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 yearly. What exactly do you mean by "retail drug costs"? Is that what I spend on my pharmacy drugs?
Answer: The "retail costs" of medications that are used to calculate when you "fall" into the Coverage Gap or Doughnut Hole are the actual negotiated cost of formulary or Part D plan cover...

Question: 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 beneficiary really know exactly when they enter and leave the coverage gap?
Answer: Leaving the Initial Coverage Phase and Entering into the Donut Hole A Medicare Part D beneficiary enters the  Doughnut Hole, Donut Hole  or Coverage Gap when their retail medication costs...

Question: Why is Fioricet with codeine covered under Medicare Part D but not plain Fioricet?
Answer: Fioricet without Codeine contains Butalbital which is a barbituate. Barbituates are one of the classes of drugs which are excluded by the Medicare Part D program by law. You can see the full list at: ...

Question: How does the Maryland SPDAP $1,200 Coverage Gap Subsidy work?
Answer: The Maryland Senior Prescription Drug Assistance Program (SPDAP) Coverage Gap Subsidy works as follows:Once you reach the Coverage Gap, you would still go to your same pharmacy and purchase your presc...

Question: 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?
Answer: Diabetic supplies are split across Medicare Part B and Part D.  Syringes and Insulin are covered under Medicare Part D, however Meters, Meter replacement batteries, Test Strips, Lancets, Lancet D...

Question: How does the premium grace period work on Medicare Part D plans?
Answer: A Medicare Part D plan must provide individuals with a grace period of not less than one calendar month. However, some plans may provide a grace period that is longer than one month. Example:Plan XYZ ...

Question: What are Medicare Part D plans required to do before an individual is disenrolled from the plan?
Answer: Medicare Part D Plans are required to: Send a bill to the person with Medicare with the amount due and due date. Send a notice (first notice) no later than 10 days after the due date if t...


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Latest Added FAQs

• 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 p...


• 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 membershi...


• 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...


• 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...


• 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 deduc...




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