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FAQs on Living with your Medicare Part D plan



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.

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Category: Living with your Medicare Part D plan

Back To FAQ Home . Browse All (41) FAQs in Category

Most Viewed FAQs in Category


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 -...

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 ...

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 ...

My father has lost his Humana Prescription Drug Plan card. how do I go about getting him a replacement card? Thank you!
Please have your father contact Humana directly to receive his replacement Member ID card.  When your father calls Humana, the Member Services representative can also provide your father with his...

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...

I want to keep my current plan for next year. What do I do?
Each year you will have the opportunity to change your Medicare prescription drug coverage and Medicare Advantage plan coverage and if you wish to keep your current Medicare Part D Prescription Drug p...

Why is Fioricet with codeine covered under Medicare Part D but not plain Fioricet?
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: ...

How does the premium grace period work on Medicare Part D plans?
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 ...

This year my Medicare Part D plan told me that Clonazepam is not covered under my Part D plan. However, my mother has the exact same Part D plan as I do and the Part D provider covers this medication for her.
You are correct in your assumption that Clonazepam is not covered by your Medicare Part D plans Clonazepam is not covered by any Medicare Part D plan. By design, certain classes of medication we...

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?
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...

. Newest FAQs in Category


I just joined a Medicare Part D plan in May. Will my new plan year start a year from now or January 1st of next year?
Your new Medicare Part D plan year will begin on January 1st of each year.The Medicare Part D plan year runs from January 1st through December 31st of each year, so the plan year runs for a calendar y...

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 ...

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 ...

My husband has already reached the "donut hole" this year. Will his coverage start over on January 1st or will he continue to be in the "donut hole"?
On January 1st, your husband's Medicare Part D plan will start over.If his Medicare Part D plan has an initial deductible, he will need to pay the initial deductible before his Initial Cover...

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.
No. The Medicare Part D program is voluntary and, like any insurance-type program, you can choose to not use your prescription drug plan and pay your prescription costs out of your own pocket - althou...

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...

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?
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...

How do I know when I will reach my Medicare Part D plan's Donut Hole or Coverage Gap?
There are a few different 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 Donut Hole (or Coverage ...

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?
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...


Back To FAQ Home . Browse All (41) 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.
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  • 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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