Do Medicare Advantage Plans Cover Prescriptions?
Are Prescription Drug Plans included with Medicare Advantage Plans?
In this article:
|What’s a Prescription Drug Plan?||Jump to|
|What’s a Medicare Advantage Plan?||Jump to|
|Medicare Advantage Plans with Prescription Drugs||Jump to|
|How to Enroll in Medicare Advantage with Prescription Drugs?||Jump to|
What’s a Prescription Drug Plan?
If you require prescription drugs to improve or maintain your quality of life, you may need to enroll in a Prescription Drug Plan. Also called Medicare Part D, Prescription Drug Plans are private insurance plans that supplement your Medicare coverage to help pay for your necessary prescriptions. Original Medicare Part A and Part B offer limited coverage for prescription drugs, which don’t include the ones you typically get from a pharmacy and administer yourself.
Ways to get your prescription drug coverage with Medicare
You have two ways to get coverage for your prescription drugs:
- Enroll in a standalone Prescription Drug Plan to supplement your Original Medicare (Part A and B).
- Enroll in a Medicare Advantage Plan that includes prescription drug coverage.
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What’s a Medicare Advantage Plan?
Medicare Advantage Plans, offered by private insurance companies, are an alternative to Original Medicare Part A and Part B. Medicare Advantage Plans are sometimes called “all-in-one” plans because they include both parts of Original Medicare and usually include prescription drug coverage.
These plans are an attractive option because they include the coverage listed above, but they may also have additional benefits, such as vision, dental, hearing and fitness memberships.
Medicare Advantage Plans with Prescription Drugs
There are five types of Medicare Advantage Plans to choose from when comparing plans. Each plan is designed to help you pay for your health care services; however, plan availability and network restrictions may vary. Some plan types are required to include prescription drug coverage, and some aren’t. Below you’ll find breakdowns of each plan and their prescription drug requirements.
Medicare Advantage HMO Plans
A Health Maintenance Organization (HMO) Plan is one of the most popular types of Medicare Advantage Plan.1 With this plan, you must get care from medical providers within your plan’s network. If you go outside your network, you may have to pay for the total cost of the health care visit or service with few exceptions.
Do HMO Plans include prescription drug coverage? – Yes, in most cases. If you want prescription drug coverage, you need to enroll in an HMO Plan offering drug coverage. If you choose an HMO plan without drug coverage, then you will not be able to enroll in a separate drug plan.
Medicare Advantage PPO Plans
A Preferred Provider Organization (PPO) Plan are plans that offer a little more flexibility than most HMO Plans. PPOs have their network of preferred doctors and specialists, but you can see out-of-network health care providers at a higher out-of-pocket cost.
Do PPO Plans include prescription drug coverage? – Yes, in most cases. If you want prescription drug coverage, you must enroll in a PPO Plan offering prescription drug coverage. If you choose a plan that does not provide drug coverage, you will not be able to enroll in a separate drug plan.
Medicare Advantage PFFS Plans
A Private Fee-for-Service (PFFS) Plan determines how much it will pay doctors, specialists and hospitals for covered services and how much you will pay to get care. PFFS Plans are unique in that you can get your health care from in-network providers or out-of-network providers if the health care provider accepts the plan’s payment terms.
Do PFFS Plans include prescription drug coverage? – Sometimes. If you want prescription drug coverage and the plan offers it, you must get your drug coverage from the PFFS Plan. If the PFFS Plans available to you don’t include prescription drug coverage, then you can enroll in a separate Medicare Prescription Drug Plan.
Medicare Advantage SNPs
Special Needs Plans (SNPs) are Medicare Advantage Plans limited to people with diseases or specific medical characteristics. These plans tailor their benefits to best help the groups they serve.
There are three types of SNPs:
- Chronic Condition SNP (C-SNP) – for people with one or more qualifying chronic medical condition
- Institutional SNP (I-SNP) – for people who live in nursing homes or need nursing care
- Dual-Eligible SNP (D-SNP) – for people who are eligible for both Medicare and Medicaid
Do SNPs include prescription drug coverage? – Yes, and all SNPs must provide prescription drug coverage. It doesn’t matter if you have a C-SNP, D-SNP or I-SNP.
Medicare Advantage MSA Plans
Medical Savings Account (MSA) Plans combine a high-deductible insurance plan with a medical savings account that helps pay for your health care costs. You can use the money in your account to pay for your health care costs, including fees not covered by Medicare. MSA Plans don’t have networks, which means you can see any doctor that accepts Medicare.
Do MSA Plans include prescription drug coverage? – No. If you join an MSA Plan, you’ll need to enroll in a separate Medicare Prescription Drug Plan.
How to Enroll in a Medicare Advantage Plan with Prescription Drug Coverage?
If you’re interested in seeing which Medicare Advantage Plans with prescription drug coverage are available in your area, you’ll need to take advantage of your enrollment periods. You’ll have the ability to make changes during the following periods:
- Your 7-month Medicare Initial Enrollment Period starts 3 months before you turn 65
- The Medicare Annual Enrollment Period between October 15 – December 7
- A Medicare-approved Special Enrollment Period
Ensurem Trusted Expertise
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1 “Medicare Advantage 2022 Spotlight: First Look,” Kaiser Family Foundation, Accessed: March 18, 2022.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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