Question: I am considering changing my prescription drug coverage to the Humana Walmart-Preferred Rx Plan and I was wondering if I can only go to Walmart for my prescriptions?
Answer: No, you do not have to use Walmart as your only pharmacy. The Humana Medicare Part D plans include over 50,000+ pharmacies in their pharmacy network.
However, you may pay much more for your prescription medications if you use a pharmacy other than Walmart, Neighborhood Market Pharmacies, Sam’s Club or Right Source (Mail Order).
As the Humana website states: “The pharmacy used to price your drugs is a part of Walmart pharmacy network. If you fill a drug at non-Walmart pharmacy, you may pay more.”
Again: Walmart, Neighborhood Market Pharmacies, Sam’s Club and Right Source (Mail Order) are the only “Preferred Pharmacies” for the Humana Walmart-Preferred Rx prescription drug plan. According to Humana, there are over 4,000 Preferred Pharmacies across the country.
You can use other pharmacies in the Humana Pharmacy Network, but the cost-sharing amount may be higher for drugs purchased outside of a Preferred Network Pharmacy.
Here is a 2012 example from the Medicare.gov website showing the different cost-sharing for the Humana Walmart-Preferred Rx plan in New York (as well as all other States and Puerto Rico) at preferred and non-preferred network pharmacies:
Please remember, this 2012 Medicare Part D plan also had a $320 Initial Deducatible. This means that you pay the first $320 of you prescription costs - before the coverage of your Part D plan begins. In this case, if you took only very inexpensive generic medications (spending under $25 per month on generic medications) you may never have met your Medicare Part D plan's Initial Deductible.
If you would like to see if your medications are covered by this prescription drug plan, you can review the the Humana Walmart-Preferred formulary by going to our Medicare Part D Plan Finder (www.PDP-Finder.com), then choosing your state from the list and then scroll down to the Humana plans. You will see a link on the right of every plan name that states: "Browse Formulary". This link will take you to the plan's formulary. You can also use our Formulary Browser found at : (http://www.Formulary-Browser.com).
2015 PDP-Finder - Medicare Part D Plan Finder The 2015 PDP-Finder displays Medicare Part D plan information, including plan premium, deductible, type of gap coverage and if the plan qualifies for the $0 premium for those persons with a low income subsidy (LIS).
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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.
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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.
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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.
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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.
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Beneficiaries can appoint a representative by submitting CMS Form-1696.