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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

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 ...

How do I contact Humana about my Medicare Part D plan?
You can telephone Humana New Member Services at:1-888-839-7316 or Humana Customer Service at:1-800-457-4708.orHumana Enrollment & Information Center at: 1-800-833-6578or Humana Billing Depart...

What is SLMB or a Specified Low Income Medicare Beneficiary?
SLMB is one type of Medicare Savings Program for the "Specified Low - Income Medicare Beneficiary" and, according to the Centers for Medicare and Medicaid (CMS), SLMB is defined as:  "A Medicaid...

Where can I get a Medical Power of Attorney form?
Please note that we cannot provide you with legal advice and Power of Attorney forms can vary state-to-state.Some states will have specific rules governing Power of Attorney forms and you may find tha...

How do I get a prior authorization form for Humana?
Humana has now moved to an online form for prior authorization. Here is a link to the Humana online prior authorization form: https://humana.promptpa.com/ ...

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...

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 ...

Where can I download a copy of the Humana Formulary
You can browse any Medicare Part D (PDP) or Medicare Advantage (MAPD) plan drug formulary online at FormularyBrowser.comOr you can click on the "Browse Formulary" link that is shown with the Medicare ...

What kind of discount can we expect in the Doughnut Hole?
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 ...

. Newest FAQs

Once I join a Medicare Part D plan and I am locked-in for the year, can my Medicare prescription drug plan drop medications from its drug list during the year?
Yes. Your Medicare Part D prescription drug plan's formulary or drug lists can change throughout your coverage year - with approval from CMS (the Centers for Medicare & Medicaid Services).  H...

Am I allowed to use a Drug Discount Program instead of my Medicare Part D plan?
Yes.  Medicare Part D prescription drug coverage is voluntary and, if you find a cheaper place to purchase medications, then you are permitted buy your medications without using your Medicare Pa...

What happens when I reach my Medicare Advantage plan maximum out of pocket limit (MOOP)?
Your Medicare Advantage plan’s MOOP or Maximum Out-of-Pocket limit is the total amount you will spend this year on co-payments and co-insurance for covered or eligible Medicare Part A (hospita...

I am not suppose to have a deductible, I get State Aid. I cannot pay for my medicine. What is going on?
There are a number of reasons that this could have happened.If you are new to the extra help program, it is possible that your assistance status is not yet up-to-date in the Medicare  system and ...

What exactly is TrOOP or True Out of Pocket costs?
The Centers for Medicare and Medicaid Services (CMS) explain that, "True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold.&...

How do I create an online account on the Humana website.
You first go to www.humana.com.Click the green sign-in or register link.  Then click on "Register Now".  Next click on the green "Get Started" button.  On the next page, first select fr...

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...

What happens after the Out of Pocket Threshold (True Out of Pocket Cost or TrOOP limit) has been met?
After you meet your Medicare Part D prescription drug plan's out of pocket spending limit, you will exit the Coverage Gap or Donut Hole phase of your Medicare plan and enter the last phase of coverage...

How do I find out if my Humana Medicare Part D plan is active?
Just enrolled in a Humana prescription drug plan?  Here are some steps that may help you use your new Medicare Part D plan - while you are waiting for your Humana Member ID card to arrive in the ...

I have chosen a plan, but I am waiting on info package. However, I need to find out what medications on Tier One or Two would match my Tier three medication. My doctor is willing to work with me, but neither of us know where to look.
You and/or your prescriber can use our Formulary Browser (http://FormularyBrowser.com) to browse through all medications on your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (fo...

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Quick Links
Medicare Part D Reminder Service: 2016
Sign-up for our Medicare Part D Newsletter.
2015 PDP-Finder: Medicare Part D (Drug Only) Plan Finder
PDP-Compare: 2014/2015 Medicare Part D plan changes
2015 MA-Finder: Medicare Advantage Plan Finder
MA-Compare: 2014/2015 Medicare Advantage plan changes
Drug Finder: 2015 Medicare Part D plan drug search
Formulary Browse: View any 2015 Medicare plan formulary
2015 Browse Drugs By Letter
PDP-Facts: 2015 Medicare Part D plan Facts & Figures
Guide to 2015/2016 LIS Mailings from CMS, Social Security and Plans


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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.
  • 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.