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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.

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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


What are drug utilization management restrictions?
Utilization management restrictions are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs and may include: Quantity Limits - limiti...

Do I get the Donut Hole discount if my Medicare plan includes Gap Coverage?
Yes - for brand-name drugs.  If your Medicare Part D (or Medicare Advantage plan) includes supplemental Donut Hole coverage, you will also receive an additional 50% discount after your plan̵...

What changes can I expect to find in my Medicare plan's Annual Notice of Change (ANOC) letter?
You can expect changes monthly plan premiums, deductibles, coverage limits, prescription drugs that are covered (brand-name and generics), drug coverage costs, pharmacy networks, provider networks (fo...

Do I get a Donut Hole discount on my non-formulary drug purchases and will these costs count toward getting out of the Donut Hole?
No. Non-formulary medications do not get a Donut Hole discount, nor do the costs count toward getting you out of the Donut Hole.  Only Medicare Part D prescription medications found on you...

Can I use a Drug Discount Card with my Medicare Advantage plan or are these programs excluded from people with Medicare?
Yes.  In general, you can use a pharmacy discount card when you are enrolled in a Medicare Advantage plan.But in reality, you are not using the discount with your Medicare Advantage plan that inc...

If I am traveling and need to buy Part D drugs, will my drug cost change based on the state where I am visiting?
No.  In general, you should find the same retail drug prices as you travel across the country.  If your Medicare prescription drug plan has a fixed co-pay (such as $30 for a 30-day supply),...

How do retail drug price increases affect my Medicare Part D drug plan coverage?
Your coverage and cost can change from what your predicted when you chose you Medicare Part D drug plan last November or December.  Retail drug prices change throughout the plan year (usually inc...

I just learned that a law was passed so that no Medicare Supplement Plan F can be sold after 2020. If I enrolled in a Plan F in 2015, will I be able to keep my Medigap Plan F beyond 2020?
Yes, it our understanding that if you are enrolled in a Medicare Supplement before 2020, you will be able to keep your Medicare Supplement Plan F after 2020. But, as many financial advisors have stat...

How will I know if I reach the Donut Hole portion of my Medicare prescription plan?
Review your Explanation of Benefits.  Each month, your Medicare prescription drug plan will send you a printed Explanation of Benefits letter that will show you how close you are to entering ...

How can I protect myself against the sun, heat, and humidity?
Protecting yourself against the sun's harmful rays can be just as important on the ski slopes as on the beach, but we often think more about the sun as the temperatures rise and we move toward summer....




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IRMAA: Higher Incomes and Costs
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Using Part D with other Drug programs
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Straddle Claims
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Pharmacies and Part D
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Traveling with your Medicare plan
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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.
  • 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.