Does Medicare Advantage Cover Prescription Drugs?

If you have to rely on prescription medications, the costs can stack up fast unless your insurance will help pay for them. Luckily for you, Medicare does offer prescription coverage under Medicare Part D.

Medicare Prescription Drug Coverage

You can get prescription drug coverage one of two ways. You can choose to enroll in a Medicare Prescription Drug Plan (PDP) that adds coverage to Original Medicare. You can add this coverage to a Medicare Savings Account Plan, a Medicare Fee-for-Service Plan as long as it doesn’t have prescription coverage, and under a Medicare Cost Plan. 

The second option is to enroll in a Medicare Advantage plan. You can choose from a Health Maintenance Organization, Private Fee-for-Service, Preferred Provider Organization, or a Special Needs Plan. A Medicare Cost Plan is another option that has coverage for your prescriptions. 

Insurance companies run Medicare drug plans along with other private companies that Medicare approves. Every plan varies in which drugs they’ll cover and the costs, so it’s important to compare plans before enrolling.

Medicare Coverage with Medicare Advantage Plans

The type of coverage and the costs you pay when you join a Medicare Advantage plan depend on which type of plan you choose. Medicare coverage will vary, but here a some of the options: 

PPO Plan

PPO (Preferred Provider Organization) plans allow you to get care from providers that aren’t in your plan’s coverage network. However, you’ll pay less when you use in-network providers. These plans usually have Medicare prescription drug coverage included, but it’s not a hard rule. If the plan you pick doesn’t have coverage for your prescriptions, you can’t join a different Medicare Prescription Drug Plan to get coverage. 

HMO Plan

As long as it’s not for emergency care, you have to use in-network providers. Health Maintenance Organization (HMO) plans typically offer coverage for prescription drugs, but they don’t have to include it. However, if your HMO doesn’t have coverage for your prescription drugs, you can’t join another Medicare Prescription Drug Plan to get coverage. 

PFFS Plan

This plan allows you to go to any state-licensed provider in the United States that provides its services under Original Medicare and accepts Medicare’s payment conditions. If your plan comes with a contracted provider network, you won’t pay as much if you choose them. You can go to any contracted provider on the plan without a penalty or paying more for it. These plans may or may not have coverage for your prescription drugs. If they don’t, you can easily join a separate plan for prescription drug coverage. 

SNP (Special Needs Plan)

The only way you can enroll in this type of Medicare Advantage plan is if you fall into the special needs population this plan is designed for. These plans have to offer coverage for prescription drugs. 

Medicare MSA Plan

Money goes into an account that you can use for any healthcare costs before you meet your deductible if you have a plan with a high rate. After you meet this deductible, the plan will kick in and cover any services. You pay into cost-sharing. There is no prescription drug coverage on this plan, and you can’t join a separate PDP to get coverage. 

Medicare Part D Coverage Options

Everyone who has Medicare gets the opportunity to switch, join, or drop their plans during Medicare’s Annual Election Period (AEP) starting on October 15 and going until December 7. Once you choose a plan, your coverage starts on January 1 of the following year. Another option is to return to Original Medicare and look for prescription drug coverage options during this time.