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If you are enrolling or are already enrolled in Medicare, you might be considering finding a plan with prescription drug coverage if you do not already have one. With Medicare, drug coverage is most commonly found in a Medicare Advantage Plan or a Medicare Part D Prescription Drug Plan. 

But, what are the differences between the plans?

What is MA?

Let’s first discuss what a Medicare Advantage Plan is. Medicare Advantage Plans, also known as Part C, offers the same benefits as Original Medicare. However, Advantage Plans can also offer additional benefits, such as dental, vision, and hearing coverage. 

There are various Advantage Plans available, the most common ones known as HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). With an HMO Plan, you must use the network of providers connected with the plan, unless you are in an emergency and cannot reach a specific provider.

With a PPO Plan, you have the option to use the network of providers or use providers outside of the network. However, if you go outside of the network, keep in mind that you may pay higher copayments and coinsurance.

What is MAPD?

Another added benefit of Medicare Advantage is prescription drug coverage. If a Medicare Advantage Plan offers this coverage, it is known as MAPD. Many MSA and PFFS Plans do not offer prescription drug coverage. However, if you are enrolled in one of these plans, you can still enroll in a Medicare Prescription Drug Plan.

Most of the time, HMO and PPO Plans do cover prescription drugs. However, if you join an HMO or PPO Plan that does not, you cannot enroll in a separate Medicare Prescription Drug Plan.

SNPs always offer prescription drug coverage.

What is PDP?

Medicare Part D is Medicare’s Prescription Drug Plan (PDP). It can be purchased as a standalone plan or with a Medicare Advantage Plan. Every PDP must offer a standard level of coverage, each plan covering at least two drugs in each category and class. If you are enrolled in a PDP that does not offer the specific prescription you are taking, the plan will more than likely have a similar drug available. However, you can always ask for an exception, but it is always best to review the plan’s specific formulary to determine if it offers the coverage that you need before settling on it.

As an independent agent, I will help you select which drug plan will work best for you. To learn more about your prescription drug coverage options, reach out to Joseph Cioffi Insurance today!