Q1Medicare.com Your Source for Medicare Part D Plan Information

Time 2020-10-08 08:02:47

Web Name: Q1Medicare.com Your Source for Medicare Part D Plan Information

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Medicare Advantage plans (MA, MAPD, SNP, MMP) Enter your zip code to compare all Medicare Advantage plans What are Medicare Part D prescription drug plans and Medicare Advantage plans? Medicare Part D prescription drug plans (PDPs) provide insurance coverage for your prescription drugs. Medicare Advantage plans (MAs or MAPDs) provide your Medicare Part A coverage (In-patient and Hospitalization) and your Medicare Part B coverage (Doctors visits and Out-Patient care) - and maybe even Medicare prescription drug coverage.Medicare Part D plans and Medicare Advantage plans are both voluntary programs and you are not required to join a plan. But you may be subject to a late-enrollment penalty if you decide to join a prescription drug plan sometime after your initial enrollment period has ended.Medicare Part D plans and Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS or Medicare) and implemented by private insurance companies (such as Aetna, Humana, and United HealthCare).If you decide to enroll in a Medicare Part D plan or Medicare Advantage plan, you will find that, like any insurance, you pay a monthly premium. The monthly premiums for a Medicare Part D PDP can range from under $10 to over $156. The monthly premiums for a Medicare Advantage plan with (MAPD) or without (MA) prescription coverage can range from $0 (or less) to $313.Medicare Part D and Medicare Advantage plans may have an initial deductible, co-payments or co-insurance, and some Donut Hole (Doughnut Hole) or Gap coverage (you can find more on these topics in our Glossary).When you enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan that offers prescription coverage, you should find that your prescription medication costs are reduced. The amount of savings depends on the Medicare plan you select. Click on this link to view all of the Medicare Part D plans in your State. Choosing a Medicare Part D or Medicare Advantage plan Medicare suggests that you look at Coverage, Cost, and Convenience - and to these criteria we also suggest you consider the Company and your level of Comfort.Coverage - Are your prescription medications covered by this plan? Are there generic alternatives for your brand-name drugs? Can you work with this plan to get a formulary exception should you need a medication that is not covered on the existing formulary? What cost-sharing applies to your medications? What health coverage does the Medicare Advantage plan offer beyond basic Medicare? Are there any additional benefits offered by the plan?Cost - What are the monthly plan premiums? Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible? What are the co-payments or co-insurance that you pay for your medications or healthcare? What are the plan's coverage limits? Is there any prescription coverage in the Donut Hole in addition to the donut hole discount? Also see: But isn t the Coverage Gap (Donut Hole) closed?Convenience - How difficult is it to find a pharmacy or a health care provider? (Note: most national Medicare Part D plans have a pharmacy network of over 50,000 pharmacies.) Are you restricted to a single healthcare network? Do your doctors accept this Medicare Advantage plan? How easy is it to work with this Medicare Part D plan or Medicare Advantage plan?Company - Are you familiar with the company or organization who provides the Medicare Part D or Medicare Advantage plan? Often people choose a Medicare plan based only the Medicare plan provider's reputation, recommendation, or Medicare star ratings.Comfort - Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan? Would you rather spend a few extra dollars per month because you know how your current Medicare plan operates and your plan costs are predictable?Still looking for more? Here are some general tips specifically for Medicare Part D prescription drug plan selection. Enrolling into a Medicare Part D plan or Medicare Advantage plan You can enroll in a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the Annual Open Enrollment Period (AEP) starting October 15th and continuing for seven weeks through December 7th. Your newly selected Medicare plan coverage starts on January 1st of the following year.You also may be eligible for a Special Enrollment Period (SEP) allowing you to change Medicare plans outside of the AEP. Read more about Special Enrollment PeriodsThe Medicare Advantage Open Enrollment Period (MA OEP) for Medicare Advantage plans begins January 1st and continues through March 31st -- during the MA OEP current members of Medicare Advantage plans can switch their Medicare Advantage plan or go back to Original Medicare and join a stand-alone Medicare Part D drug plan.If you are just turning 65 or newly eligible for Medicare, you will be granted a seven (7) month Initial Enrollment Period (IEP) during which you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month.Find a Medicare Part D planFind a Medicare Advantage planYou always pay the same amount for a Medicare Part D plan or Medicare Advantage plan, no matter where or how you enroll. You can enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 10 business days you should receive your Medicare Part D new member information. Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan's Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card. What is a Medicare Part D plan? Medicare Part D prescription drug plans provide insurance coverage for out-patient prescription drugs.A Medicare Part D plan works just like any other types of insurance:(1) You usually pay a . . . How do I drop my Medicare Part D prescription drug plan? You can drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the annual Open Enrollment Period - or a Special Enrollment Period - or you can be involuntarily disenrolled from your plan. What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap? You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap.As background, starting back in the 2011 Medicare Part D plan year, a discount or co-insurance (cos . . . 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 MedicarePart D prescription drug plans (PDPs) or Medicare Advantage plans that includeprescription drug coverage (MAPDs) . . . What are the Medicare Part D Special Enrollment Periods (SEP)? A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop theirMedicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD)outside of the ann . . . Q1Rx.com Prescription Drug Search Tool Q1Rx is designed for fast, medication searches and provides plan details, cost-sharing, and average retail drug price, and drug usage management information for your covered medication. With Q1Rx, you can search for a medication different ways and find the coverage details for all Medicare Part D plans in your state.See if a particular drug is covered by ANY Medicare Part D plan in your state. Click here for an example of plans covering 10MG Atorvastatin [generic Lipitor] in Texas.See if a drug is covered by your particular Medicare Advantage plan s drug formulary. Click here for an example of Aetna Medicare Advantage plans covering 40MG ESOMEPRAZOLE [generic Nexium] in Summit County, Ohio.Compare drug costs coverage between two different carriers. Click here for an example of how Humana and AARP plans compare for 100MG Quetiapine Fumarate [generic Seroquel] in California.Not sure how to spell the name of your drug? Just type in the first three letters and choose from the list of possibilities.Do you know the NDC (11-digit National Drug Code) for your medication? Just type it in, select your state and click on Search .Is this all a bit too complicated? No problem, we have a basic drug search tool that you can use. Click here for our Basic Drug Search example of all PDP plans covering 10MG AMLODIPINE BESYLATE [generic Norvasc] in Pennsylvania.Want to browse all medications on your plan s formulary (list of covered drugs)? Our Formulary Browser (https://Formulary-Browser.com) shows covered drugs along with their cost-sharing, average retail price and drug usage management.2020 Federal Poverty Level Guidelines (FPL): 2020/2021 LIS Qualifications and Benefits The 2020 Federal Poverty Level (FPL) Guidelines determine the income level requirements for people applying for the Medicare Part D Low-Income Subsidy (LIS) program, also known as the Extra Help program that helps pay Medicare prescription drug costs.2020 IRMAA: Slight Decrease in Medicare Part D IRMAA payments for most along with larger decreases for some as IRMAA brackets become annually inflation adjusted. Starting in 2020, the Income-Related Monthly AdjustmentAmount (IRMAA) income brackets will be adjusted for inflation. Consequently, people at the low end of their 2019 IRMAA income bracket wil . . .2021 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006 CMS released the 2021 low-income premium subsidy amounts (or Benchmark premiums) for Medicare Part D plans on July 29, 2020. In 2021, four regions will lower their Medicare Part D Low-Income Subsidy (LIS) benchmark premiums and 30 regions will increase their benchmark premium.Preview Medicare Part D 2021: CMS releases the proposed 2021 Medicare Part D standard drug plan coverage parameters On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Advance Notice and Draft Call Letter that included the 2021 proposed defined standard benefits for Medicare Part D prescription drug plan coverage - and proposed changes to Medicare plans.Understanding the 2020 Medicare Part D Donut Hole The Donut Hole (or Coverage Gap) is aterm used to describe a "gap" or pause in your Medicare Part D prescription drug coverage where - prior to 2011 - you were 100% responsible for the cost of your . . . Stay Informed with our Medicare Part D Newsletter Join the thousands of people who receive our Medicare Part D Newsletter. Our free Newsletter is published on a regular basis and provides details on various areas of your prescription drug plan coverage. New Medicare developments, frequently asked questions, and even more complex areas of Part D coverage are included. We also welcome reader input and suggestions for new topics. Sign up below. Please note, that we never share your personal information with other parties. If you receive the full Extra-Help, full LIS, or are dual eligible for Medicare and Medicaid, there are Medicare Prescription Drug plans in your state the will qualify for the $0 monthly premium. Click below to review our state benchmark premium Blog. You can click on the benchmark premium for your state to review all plans qualifying for the $0 monthly premium. 2021 Medicare You Handbook Available for download as PDF (in English Spanish plus archive). For a printed version of this 124 page document, please telephone Medicare at (1-800-Medicare). What can we expect from 2021 Medicare Part D plans? The Centers for Medicare and Medicaid Services (CMS) publishes basic Medicare Part D benefit parameters that are used as a standard for the design of Medicare Part D plans offered by private Medicare Part D plan providers. The 2021 CMS standard Medicare Part D plan provides:2021 standard Initial Deductible: The maximum initial deductible is $445 (up from $435 in 2020). 2021 Initial Coverage Limit (ICL): The 2021 ICL is $4,130, up from $4,020 in 2020. The 2021 Coverage Gap (also known as the Donut Hole): After you meet your ICL and until your Total Out-of-Pocket (TrOOP) costs (not including plan premiums) reaches $6,550, you pay 25% of your plan s negotiated retail price for formulary prescriptions. This is known as the donut hole discount. Also see: But isn t the Coverage Gap (Donut Hole) closed?Catastrophic Coverage: Once your TrOOP (total drug spending) has reached $6,550, you pay only a maximum of 5% of the retail price for your covered drugs or a co-payment of $3.70 for covered generics and $9.20 for covered brand-name drugs, whichever cost is greater.Click here to see a comparison of the 2021, 2020, 2019, 2018, and 2017 standard CMS Medicare Part D plans.Read more about the 2021 standard Medicare Part D benefits. PDP-Planner helps you prepare for your 2021 plan costs You can begin to prepare for your 2021 Medicare Part D prescription drug spending now. Millions of Medicare Part D beneficiaries enter the Donut Hole or Coverage Gap each year -- and most people do not exit the Donut Hole, but instead stay in the Donut Hole through the remainder of the year. Would you like to estimate your budget for prescription drug in 2021? Use our free PDP-Planner to plan now for 2021.You can also use calculators from prior plan years to compare your previous experiences. You can then adjust the results from PDP-Planner to better estimate your total 2021 prescription drug costs. 2020 2019 2018 2017 Compare Local Pharmacy Prices Using a Drug Discount Card Prescription Discounts areeasy as 1-2-3 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.

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Providing information and online tools for the Medicare Community on the topics of Medicare Part D prescription drug plans, Medicare Advantage plans, and original Medicare. Detailed information on Medicare Prescription Drug plans is available for every state, including Plan features and costs. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk - Powered by Q1Group LLC

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