If you have a Medicare Advantage plan and your benefits include prescription drug coverage, you will automatically be dropped from the Medicare Advantage plan if you enroll in a Medicare Part D Prescription Drug Plan, or PDP. Instead of being covered by your Medicare Advantage policy, you will receive coverage under original Medicare Part A and B. You will also receive prescription drug benefits under the PDP that you enrolled in.
If your Medicare Advantage plan does not include prescription drug coverage, you may receive prescription drug benefits while keeping your Advantage benefits. When you're choosing a Medicare Advantage program, consider the prescription drug benefits that you need. If you take medications that are not covered under Medicare Part A or B, a plan with Medicare Part D prescription drug coverage could help you avoid paying high out-of-pocket costs for medications.
Medicare Advantage Plans
Medicare Advantage policies are also known as Medicare Part C plans. Medicare Advantage plans combine the inpatient benefits you receive under Part A with the outpatient benefits that you receive under Part B. Advantage plans may also include Part D money saving benefits, which cover medically necessary therapeutic drugs. Medicare Advantage plans that include Part D prescription drug coverage are known as MAPDs.
Medicare Advantage policies are managed by private insurance companies, which are sponsored by the federal government. There are several basic types of Medicare Advantage plans available to seniors, including Medicare Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs), and Medical Savings Accounts (MSAs). Within each group, each plan may handle prescription drug coverage differently.
Some Advantage plans in all of these basic categories include prescription drug coverage, and some do not offer this benefit. If your Advantage plan does not offer prescription drug coverage, you may enroll in a PDP without being disenrolled from your Advantage plan. Enrolling in a PDP plan should not change your Medicare Advantage status or affect your benefits unless your Advantage plan includes prescription coverage. If you are enrolled in an Advantage plan, check with your provider about any restrictions before enrolling in a Part D plan.
Medicare Prescription Drug Plans
Medicare PDPs may be combined with your original Medicare benefits or with an Advantage plan that does not include prescription drug coverage. Many seniors add a PDP to a Medical Savings Accounts or Private Fee-for-Service Plans to receive comprehensive coverage for their health care needs. A PDP may be issued by a private insurance company or by a government organization. The costs of a PDP may include a monthly premium, a deductible and a co-payment for your prescriptions.
Because Medicare Part D benefits are administered differently by each PDP provider, it is important to compare benefits and costs from several providers before you choose a plan. If you enroll in a PDP and you are covered under an Advantage plan, your overall health care costs may increase. However, you will receive valuable financial support to help you with the costs of medications that aren't covered under Medicare Part A or B.
When you enroll in any new Medicare plan other than original Medicare, you may disenrolled from an Advantage or PDP plan that provides equivalent benefits. Consult several insurance providers before you choose a PDP or Advantage plan. Compare the cost of adding a Medicare PDP to your original Medicare benefits, versus the cost of adding a PDP to an MSA, PFFS or other Medicare Advantage plan. Before you make any changes to your coverage, review the terms of your policy to ensure that you won't lose any current benefits.
