. . .
. . .
Powered by Q1Group LLC Powered by Q1Group LLC.
Education and Decision Support Tools for the Medicare Community
. . .
. . .
. . .
. Home Contact Us MAPD PDP . .
. . 2016 FAQs Latest Medicare News
. . .
. . . . . . .


» Click here to link to this page on your website

    Follow Q1Medicare on Twitter
. .

Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Browse the Most Viewed and Newest Medicare Part D FAQs
If you still have questions, please contact us through our Online Help Desk.

. . .
Most Viewed FAQs

I am new to Medicare. Where can I get an overview of the Medicare Part D program?
In general, Medicare Part D prescription drug plans provide insurance coverage for your prescription drugs - just like other types of insurance. Your Medicare prescription drug coverage can be prov...

How will I choose between a stand-alone Medicare Part D prescription drug plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)?
Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs)...

What are the Medicare Part D Special Enrollment Periods (SEP)?
Usually, most seniors or other Medicare beneficiaries can only change their Medicare Part D or Medicare Advantage plan coverage during the annual Open Enrollment Period (AEP or Annual Enrollment Perio...

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 ...

If I decide not to join any Medicare prescription drug plan, and I do not have any other prescription coverage, how long will I have to pay the late-enrollment premium penalty?
Probably forever.  The late-enrollment premium penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D prescription drug plan (o...

How does the Income-Related Monthly Adjustment Amount (or IRMAA) affect me and my Medicare plan premiums?
IRMAA means that, based on your income, you will pay higher premiums for your Medicare Part B and Medicare Part D coverage.As noted by the Social Security Administration:  If you have higher annu...

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?
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 p...

What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap?
Starting back in the 2011 Medicare Part D plan year, a discount or co-insurance (cost-sharing) was introduced to reduce the cost of generic and brand-name prescription drugs purchased by non-LIS ...

I am on Medicaid and Medicare assigned me a Part D plan that does not cover one of my medications. What do I do?
You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients both receive a continuous Special Enrollment Period and ca...

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 user...

. Newest FAQs

Can I be assessed an Income Related Monthly Adjustment Amount (IRMAA) for Medicare Part D if I am enrolled in a Medicare Advantage HMO plan?
Yes.   If your annual income exceeds certain limits - and you are enrolled in a Medicare Advantage (HMO, PPO, or PFFS) plan that includes prescription drug coverage  (MAPD), then your M...

Do you provide a system where we can enter a list of drugs, save them, and then compare the annual costs for each Medicare Part D plan?
No.  We designed our Q1Medicare drug search tools for people who wish to quickly check the coverage of a single formulary medication across all Medicare Part D prescription drug plans (PDP) or Me...

I didn't pay my plan premiums and was disenrolled from my Medicare Part D plan. What is the "good cause" that I must show to be reinstated in my plan?
If you receive a notification that you have not paid your Medicare plan premium, telephone your Medicare plan’s Member Services department immediately (the toll-free number is on your Member I...

What is a Medicare Advantage plan and how does a Medicare Advantage plan compare to a stand-alone Medicare Part D plan?
Medicare Advantage plans can be divided into two groups: (1) Medicare Advantage plans with prescription drug coverage (MAPD) and (2) Medicare Advantage plans without prescription drug coverage (MA).&n...

Can I get a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan's network?
Maybe, this particular Special Enrollment Period (SEP) is exceptional, and will only be granted if the changes to your provider network are considered as "significant".   As you may know, you...

What is the Initial Coverage Limit? Can the limit vary between Medicare Part D plan providers?
Your Initial Coverage Limit (or ICL) is the boundary between your Medicare Part D plan's Initial Coverage Phase and the Donut Hole or Coverage Gap.  The ICL is the total retail value of formulary...

If I move to another state, is there a Special Election Period or SEP to join another Medicare Part D plan in my new area?
Yes.  When you move outside of your Medicare Part D or Medicare Advantage plan's Service Area, you are granted a Special Enrollment Period to join another Medicare plan outside of the annual Ope...

If I'm already enrolled into a Medicare Part D plan, can I still change how I pay my monthly premiums?
Yes.  You can contact the Member Services department of your Medicare Part D or Medicare Advantage plan if you wish to change how you pay your monthly premiums.  The toll-free Member Se...

If I am Dual Eligible and qualify for Extra Help, will my Medicare Part D drug plan premium always be $0?
Not always.  If you are "Dual Eligible", qualifying for both Medicare and Medicaid, you will automatically qualify for the Medicare Part D full Low-Income Subsidy (LIS) or Extra Help program. ...

If I enroll in a Medicare prescription drug plan that has an initial deductible, will the deductible impact when I go into the Donut Hole?
No.  If your Medicare Part D plan has an Initial Deductible, you will pay first 100% of your prescription drug costs until you have met the deductible.For instance, if your drug plan has a $360 d...

Click the +1 button if you have found this page useful:  


Browse Categories
Q&A of the Day
Where do I start?
General Medicare Part D
Medicare Advantage plans (MAPD)
Medicare Supplements or Medigap
Choosing a Medicare plan
Medicare Part D Enrollment
Medicare Enrollment Periods
Medicare plan Disenrollment
The Late-Enrollment Penalty
Special Enrollment Periods (or SEPs)
Paying Your Premiums
Medicaid & Extra Help & LIS
IRMAA: Higher Incomes and Costs
ANOC: Annual Plan Changes
Switching Medicare Part D plans
Medicare plan Star Ratings
Living with your Medicare Part D plan
Using Part D with other Drug programs
Explanation of Benefits (EOB)
Understanding your Formulary
Monthly Formulary Changes
About Specific Drugs
Formulary Exceptions
Straddle Claims
Retail Drug Pricing
Pharmacies and Part D
Medicare plan Providers
Traveling with your Medicare plan
Moving and Medicare Part D
The Coverage Gap or Donut Hole or Doughnut Hole
Entering the Donut Hole
Closing the Coverage Gap
Donut Hole Discount
Exiting the Donut Hole
Out of Pocket Costs: TrOOP and MOOP
Diabetes and Diabetic Coverage
VA and TRICARE Coverage
Q1Medicare.com Tool Tips
Other Q1Medicare.com Questions
General Medicare
Medicare and the ACA Marketplace
Medicare Part B
Medicare Set Aside Arrangements
Important Disclaimers and Tips
$250 Doughnut Hole Rebate

Quick Links


. . .
. . .
Sitemap About Us Newsletter Sign-up Latest Medicare News FAQs Contact Us Privacy Policy Terms Of Use Press
. . © Q1Group LLC 2005 - 2016 . .
. . .
. . .
. .
. .


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.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • 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.