Does Medicare Advantage Provide Prescription Drug Coverage?

In Missouri alone, there are over 1.2 million residents enrolled in Medicare (including Medicare Advantage), with 122 Medicare Advantage plans available in 2021. This is a significant increase from 97 Medicare Advantage plans in 2020.

Eligible Missourians also have access to $0 premium Medicare Advantage plans, with the average premium being $9.59 as of 2021, making these plans an affordable option!

A majority of Medicare Advantage plans also provide Part D (prescription drug) coverage. But what does this look like? How does it work? What if your Advantage plan doesn’t cover prescriptions? InvoBH can answer these questions for you (and more).

What is Medicare Advantage and Part D?

Medicare Advantage (Part C) provides some healthcare at a lower cost and a few extra benefits than Original Medicare. This is accomplished by a network of services and benefits, with which the Advantage plan negotiates so that the Medicare beneficiary pays less out-of-pocket costs.

One of the benefits offered by most Advantage plans is Part D. Part D provides prescription coverage for a huge variety of necessary drugs, and will likely include some coverage for almost anything that is medically necessary.

How Part D Works with Medicare Advantage

The term “MA-PD” refers to Medicare Advantage plans that include prescription drug coverage, while “PDP” refers to prescription drug plans on its own. There are 6 different types of Advantage plans. None of them, with the exception of SNPs, are required to include Part D coverage, but most of them do nonetheless:

  • Health Maintenance Organization (HMO): These plans offer a small network of coverage that must be used unless in the case of an emergency. They are one of the least expensive options.
  • Preferred Provider Organization (PPO): PPO plans have a bigger network of coverage than an HMO, and offer some coverage if you go outside of said network, even if it is not an emergency. Like an HMO, all emergency care is covered.
  • Private Fee-for-Service (PFFS): PFFS plans allow the beneficiary to visit any healthcare provider, regardless of a network, so long as they agree to the terms of the plan.
  • Medicare Savings Account (MSA): 
  • Special Needs Plan (SNP): 

Adding Prescription Drug Coverage to Medicare Advantage

In the unlikely event that your Advantage plan does not include Part D, you may still be able to add it to your plan. D-SNPs and C-SNPs are the only plans required to offer it. According to Medicare’s website, if your HMO or PPO does not come with Part D, you cannot add a separate PDP. You can, however, add a PDP to your PFFS or MSA plan if it is not included.

If you are concerned about whether or not an Advantage plan includes Part D, make sure to “shop around” and compare options in your area. You can also work with an agency that will do this for you.

Don’t Go Without the Coverage You Need—Call InvoBH

Don’t be worried about finding a Medicare Advantage plan on your own—work with someone who will address your needs and do the hard work for you. Call InvoBH today.