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May, 05 2024 — If you are enrolled in a Medicare Part D prescription drug plan (PDP or MAPD), you will need to visit one of your plan's network pharmacies to receive the cost-saving benefit of your Medicare drug pla . . .
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May, 04 2024 — Probably not. In some situations, you have the right to ask your Medicare Part D prescription drug plan to move a higher-costing drug to a lower-costing formulary tier. However, usually such a "tiering exception" is not available for plans with only one Specialty Drug
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May, 02 2024 — Yes, in some situations you have the right to ask your Medicare prescription drug plan to move a formulary medication to a lower-costing formulary tier. But, you cannot reduce the cost of a Tier 5 Specialty drug, nor can you reduce the cost of a now-covered, non-formulary drug.
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May, 02 2024 — No. A Medicare Part D plan will not allow you to request a tiering exception for a drug (moving a drug to a lower-costing formulary tier) when your plan has just approved your formulary exception request to cover the non-formulary drug.
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May, 02 2024 — The cost of covering a non-formulary drug will depend on your Medicare drug plan. Your Medicare Part D plan has some flexibility with regard to what you will pay for the coverage of a non-formul . . .
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May, 02 2024 — A formulary exception is a type of coverage determination request whereby a Medicare plan member asks their Medicare Part D plan to cover a non-formulary drug or amend the plan's usage management restrictions that are placed on the drug.
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May, 02 2024 — Ask for a transition fill of your existing non-formulary drug, check for alternative drugs or generics covered by your Medicare drug plan, ask for a formulary exception covering the non-formulary drug, appeal any negative decisions, and finally use a Drug Discount card.
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Apr, 30 2024 — Maybe. Even with the 75% Donut Hole discount, you may find that you are paying more for your formulary drugs when you leave your Initial Coverage Phase and enter the Coverage Gap - depending on whether or not you were paying less than 25% of retail in your Initial Coverage Phase.
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Apr, 24 2024 — 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". In addition, you cannot simply . . .
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Apr, 23 2024 — A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their
Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD)
outside of the ann . . .
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Apr, 23 2024 — Yes. If you use a Special Enrollment Period (SEP) to change Medicare drug plans during the year, you will find that both the total retail value of your drug purchases and the total value of your out-of-pocket spending (TrOOP) transfer to your new Part D plan.
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Apr, 23 2024 — Yes. Medicare Part D prescription drug plans
(PDPs and MAPDs)
are required to keep track of each person’s prescription drug spending or TrOOP costs -
so your out-of-pocket spending and . . .
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Apr, 23 2024 — If you use a Special Enrollment Period to change Medicare Part D drug plans during the year, your drug purchase history moves with you to your new Medicare plan. So if you are in the Donut Hole and move to another Part D plan, most likely you will still be in the Donut Hole.
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Apr, 23 2024 — Maybe. If you are able to change or transfer to another Medicare Advantage plan offered by the same company during the plan year, you may be able to transfer the amount that you have spent for your Medicare Part A and Part B coverage toward your new plan's MOOP limit.
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Apr, 20 2024 — If you are a Medicare beneficiary with higher annual earnings, you may be assessed an Income-Related Monthly Adjustment Amount (or IRMAA) which is an additional amount that you pay together with your . . .
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Apr, 20 2024 — Yes. Even though Medicare plans sanctioned by the Centers for Medicare and Medicaid Services (CMS) are not allowed to accept new enrollment, Q1Medicare® shows “sanctioned” Medicare pl . . .
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Apr, 20 2024 — 95% of your brand-name drug's retail cost is counted toward exiting the Donut Hole.
If your monthly purchases of formulary medications consistently have a retail value of
over $420,
you will ex . . .
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Apr, 20 2024 — Yes. Medicare provides a Special Enrollment Period (SEP) for people who left their Medicare Supplement (Medigap plan) and joined a Medicare Advantage plan for the first time and now within the 12-month trial period wish to return to their Medicare Supplement.
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Apr, 20 2024 — The Medicare Part D late enrollment premium penalty (LEP) is an additional cost you will pay every month because you did not enroll into a Medicare Part D prescription drug plan when you were initiall . . .
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Apr, 20 2024 — There are several reasons why you are paying more this year for your drugs even when you are in the same Medicare plan: Your drugs are no longer covered or covered at a higher price, you used a non-network or standard pharmacy, you lost Extra Help benefits, and more . . .