If you’re considering Medicare Advantage (MA), you’re not alone. With benefits above and beyond Original Medicare, the right MA plan offers security and peace of mind that when you need health care, you can get it—no questions asked. But what about prescription drug plans? Are you covered under Part C? Here’s a brief overview of how prescription drug benefits work with Medicare Advantage and information on MA Plans that include prescription drugs, called (MAPD).
Coverage Depends on the Type of Plan
There are many different types of Medicare Advantage plans, some with prescription drug benefits included, and some without. Medicare Advantage HMOs and PPOs are not required to offer prescription drug benefits. If you choose an HMO or PPO MA plan that does not offer coverage, you may not join a separate Medicare Prescription Drug plan.
Compare Prescription Drug Benefits
The good news is, that most Medicare Advantage plans do include benefits for prescription drugs, known as MAPD, but no two plans are alike. It makes sense to find the one that fits your prescription needs best. If you take specific medications, compare plans by looking at the drugs that are included on the formulary (list of covered medications), and be sure to identify which tier or tiers they are assigned to, how much they cost, and where you can get them.
Your Drug Benefits May Change Yearly
You already know that different Medicare Advantage plans provide different prescription drug benefits. But did you know that each plan’s benefits might change yearly too? If you have Medicare Advantage with prescription drug coverage, your plan is required to send you an Annual Notice of Change each year. This document (which should come by mail at the end of September) informs you about any changes that will take place the following January to your plan in network pharmacies, drug formulary, and cost for medications you take.
References:
Different types of MA plans: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/types-of-medicare-advantage-plans.html
How Medicare Prescription Drug Coverage Works with a Medicare Advantage Plan, https://www.medicare.gov/Pubs/pdf/11135.pdf page 2, 3
Medicare Advantage enrollment, 2016, http://kff.org/medicare/fact-sheet/medicare-advantage/
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