Medicare Part D – Frequently Asked Questions (FAQ)
UPDATED Oct. 27, 2023. Here are several categories of Medicare Part D Frequently Asked Questions (FAQ).
Article Contents
- Medicare Part D Cost
- Changing Medicare Part D Plans
- Medicare Part D Coverage Gap (Donut Hole)
- Miscellaneous
- US Government Sources
Medicare Part D Cost
Here are Medicare Part D Frequently Asked Questions (FAQ) for Part D Cost.
Q1. What are the typical ways to lower your drug costs?
The most popular ways to lower drug costs include: (a) looking for generic alternative drugs, (b) consider preferred or mail-order pharmacies, (c) check if you may be qualified for Pharmaceutical Assistance Programs, such as PACE/PACENET (see Q5), (d) use low cost Generic Drug Programs (see Q6)
Q2. Are brand-name drugs superior to generic drugs?
It is a prevalent misconception. The generic drugs are interchangeable with brand-name drugs. They appear on the market once the patent of the original drug manufacturer has expired. They are less expensive because they do not need to cover the original drug manufacturer’s expenses for research, development, promotion, and advertising.
Q3. I have prescribed a lot of generic drugs. What plan should I look?
Look for the tier-based plan that will charge you nothing or lower copayments for generic prescriptions.
Q4. I have very few drug prescriptions. What plan should I look for?
Look for a plan with zero or low monthly premiums. You may consider changing your plan in the future when you’ll use more drug prescriptions.
Q5. What are other Prescription Drug Coverage Options?
It depends on the state in which you reside. For example, in Pennsylvania, there is a PACE/PACENET program – a state prescription plan for Pennsylvania residents age 65 and above who meet eligibility requirements. There are also other programs: TRICARE, Veteran’s benefits, etc.
Q6. What are low-cost Generic Drug Programs?
Many chain stores and grocery store pharmacies (Wal-Mart, Target, Costco, etc.) are offering the most commonly used generic drugs at very low cost. Anybody can participate in these programs.
You also should consider GoodRx, and Mark Cuban’s Cost Drug Plus Company.
Changing Medicare Part D Plans. Switching from the stand-alone Part D plan to MAPD.
Q7. Can I use one plan for my health and drug prescription benefits?
Yes, you may consider switching from Original Medicare and Medicare Part D Plan to Medicare Advantage plan with Drug Prescription (MAPD)
Q8. When should I consider changing my Medicare Prescription Drug Plan?
Once selected, most Medicare beneficiaries do not want to change their Medicare Plan D plan from one year to the next. However, there is a high probability that the plan that was optimal this year will have more substantial costs the following year. Each Medicare Prescription Drug plan is required to provide to its members the Annual Notice of Change by September 30. It includes both changes in benefits and costs. Therefore, review the plan changes and if you’re ready to change the plan, do it at the Medicare Open Enrollment Period (October 15 – December 7). The coverage will begin on January 1 of the following year. Remember:
- Compare the benefits and costs of your present plan with those of other plans.
- If you’re ready to make a change, sign up as soon as possible. It’ll help you to guarantee the uninterrupted coverage.
Medicare Part D Coverage Gap (Donut Hole)
Here are Medicare Part D Frequently Asked Questions (FAQ) for Part D Donut Hole.
Q9. How can I avoid or delay reaching the Coverage Gap?
Try to reduce your out-of-pocket drug expenses by using generic drugs or lower cost brand-name drugs.
Q10. How can I receive some coverage during the donut hole?
Enroll in a drug ‘enhanced plan.’ It’ll provide you with some coverage during the gap (such as generic drugs), usually for an extra premium.
Q11. Are there any exceptions from the Coverage Gap?
Yes, people with limited income and resources who qualify for Extra Help are NOT affected by the coverage gap. They will continue to pay the same copayment.
Q12. Should I use the Medicare Part D plan card during the donut hole?
Always use your Medicare Part D plan card, even during the donut hole. It’ll allow you to buy the prescription drugs at the plan’s negotiated prices, and to track and calculate your out-of-pocket costs automatically.
Medicare Part D Frequently Asked Questions (FAQ) – Miscellaneous
Q13. Can I use my pharmacy discount card to buy prescription drugs? Will these costs count towards my out-of-pocket expenses?
Yes, if you are using the ‘network pharmacy.’ Your drug expenses that are based on pharmacy discount are applied towards your out-of-pocket costs.
US Government Sources
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