If you’re enrolled in Original Medicare and need prescription drug coverage, you may be trying to decide whether to get your benefits through Medicare Advantage (also known as Medicare Part C) or a stand-alone Medicare Prescription Drug Plan (also known as Medicare Part D).
So, which type of coverage offers better prescription savings? While the answer varies depending on your specific situation, here are a few factors to consider as you compare Medicare Advantage with stand-alone prescription coverage options.
Prescription drug costs without Medicare coverage
If you don’t have Medicare Part D, you’re responsible for the full cost of your prescription drugs, unless you qualify for state assistance. In addition, if you ever enroll in a Medicare Advantage plan or stand-alone Part D Prescription Drug Plan later on and went without Part D for a period of 63 days or more, you could owe a late-enrollment penalty for as long as you have Medicare Part D.
Comparing coverage: Medicare Advantage vs. Medicare Prescription Drug Plans
Both Medicare Advantage and Medicare Prescription Drug Plans (Medicare Part D Plans) are available through Medicare-approved private insurance companies. The biggest difference is that Medicare Advantage plans that cover prescription drugs also include Part A and Part B benefits, and may include extra coverage beyond Original Medicare, such as routine vision or dental. Stand-alone Medicare Prescription Drug Plans only offer Part D benefits.
Most Medicare Advantage plans include prescription drug benefits, but not always, so check with the specific plan. Some Medicare Advantage plans, such as Medicare Advantage Special Needs Plans, are required to include prescription benefits, while other types, such as Medicare Advantage Medical Savings Account plans, never include this coverage.
Comparing costs: Medicare Advantage vs. Medicare Prescription Drug Plans
Both Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans may have the following costs:
- Yearly deductible
Keep in mind you’ll need to keep paying your Part B premium if you’re enrolled in Medicare Part C.
Whether you have a Medicare Advantage Prescription Drug plan or a Medicare Prescription Drug Plan, the plan should have a formulary, or list of covered medications. The formulary places all covered medications into “cost tiers,” with different copayment and coinsurance costs, depending on which tier they fall under. Always check the formulary of the Medicare Advantage or Medicare Prescription Drug Plan to make sure your medications are covered. The formulary may change at any time; your Medicare plan will notify you if needed.
Other factors that may affect your prescription drug costs include:
- Whether you qualify for Extra Help
- Whether your income falls above a certain amount
- Whether you enter the coverage gap (“donut hole”)
- Whether you take brand-name or generic drugs
- Whether you use in-network pharmacies
Is a Medicare Advantage Prescription Drug plan right for me?
With Medicare Part C, many beneficiaries like the convenience of having all of their coverage through a single Medicare Advantage plan. Also, if you’re interested in benefits that Original Medicare doesn’t cover, such as health wellness programs or routine vision, a Medicare Advantage plan could offer extra coverage for these services.
Ultimately, your prescription drug costs and savings will depend on your unique situation and prescription needs. Remember that Medicate Advantage Prescription Drug plans and stand-alone Medicare Prescription Drug Plans can vary in coverage and costs – even when the medications are the same.
Finding Medicare Advantage and Medicare Prescription Drug Plans
The best way to save money is to carefully research and compare plans in your area. A licensed insurance agent can help you find a Medicare Advantage plan or Medicare Prescription Drug Plan options that cover your medications.
If you’d like to learn more about whether a Medicare Advantage plan or Medicare Prescription Drug Plan could fit your needs, I’d be happy to help. To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
The pharmacy network may change at any time. You will receive notice when necessary.
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