Medicare is a health insurance program by the U.S. government and offered to individuals ages 65 and over, some eligible adults with disabilities, and individuals with Renal Disease at End-Stage. Its coverage has a crucial part to play in covering medical expenses as one age. While this sounds agreeable, Medicare benefits doesn’t pay for all.

A popular alternative to Medicare is the Medicare Advantage (MA) provided by private insurers that are in contract with Medicare. Also referred to as Medicare Part C, Medicare Advantage makes it possible for individuals with hospital insurance (Medicare Part A) and medical insurance (Medicare part B) to obtain their benefits from Medicare in a different way.

A “package deal” plan is what Medicare Advantage is. These “all-in-one” plans have at least similar coverage level of Medicare Part A and Medicare Part B, and typically includes Medicare Part D (prescription drug coverage) as well. They may have out-of-pocket costs that are lower compared to Original Medicare and most Medicare Advantage plans offer additional benefits that Original Medicare doesn’t offer or cover, such as hearing, vision, dental, and more.

Medicare Advantage And Prescription Drug Coverage

Some Medicare Advantage plans bundle health insurance benefits as well as prescription drug coverage in a single comprehensive package known as Medicare Advantage Prescription Drug plan or MAPD plan. Similar to every MA plans, MAPD plans cover all that Medicare covers (Part A and Part B), except for hospice care that is under Medicare Part A. As mentioned, these plans could include extra benefits like routine dental and vision, hearing, as well as access to health and wellness programs.

There are a number of MAPD plan types and each may have varied rules regarding how you could obtain care.

  • Health Maintenance Organization Plans. HMO Plans, in most cases, cover prescription drugs. If you would want Medicare drug coverage or Part D, you need to join an HMO plan offering coverage on prescription drugs.
  • Preferred Provider Organization Plans. PPO Plans cover prescription drugs in most instances. To get Medicare drug coverage, you have to be enrolled to a PPO Plan providing prescription drug coverage. Joining a PPO plan not offering coverage for prescription drugs won’t qualify you for Medicare Part D.
  • Private Fee-for-Service Plans. PFFS Plans may cover prescription drugs. If the PFFS plan do not provide coverage for prescription drugs, you can get coverage by joining a Medicare Prescription Drug Plan.
  • Special Needs Plans. Every SNPs should offer Medicare prescription drug coverage.

If you want to get benefits on prescription drug coverage with your Medicare Advantage, if available, you generally have to join a Medicare Prescription Drug plan, not a separate Medicare Prescription Drug Plan. In the main, Medicare Prescription Drug Plans are intended to work together with Original Medicare, not an MA plan.

It is crucial that you have an understanding of how your actions may impinge on your coverage. If you are already enrolled in a Medicare Advantage plan the covers prescription drugs and you join a Medicare Prescription Drug Plan, you will automatically be unenrolled from the MA plan returning you to Original Medicare.