Summary: People with Medicare Part A and Part B have the option of getting prescription drug coverage from:
- A stand-alone Medicare Prescription Drug Plan (Part D) if they stay with traditional Medicare insurance, or
- From a Medicare Advantage Prescription Drug plan (Part C)
A Medicare Advantage Prescription Drug plan (Part C) may save you money in premium expenses. But to take full advantage of potential savings, you need to compare formularies to make sure your medications are covered. You’ll also want to ensure retail pharmacies are in the plan’s network.
Millions of people with Medicare turn to stand-alone Medicare Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans (Part C) to get help paying for their prescription drugs.
You may be wondering which type of coverage offers the better prescription drug savings. It’s likely that the plan you choose has more to do with your prescription drug coverage cost savings than the type of coverage you choose.
Distinctions: Medicare Advantage Prescription Drug Plans (Part C) vs. Medicare Part D Prescription Drug Plans
Medicare Advantage (Medicare Part C) Prescription Drug plans provide coverage for health care, as well as prescription medications (Medicare Part D). A standalone Medicare Part D Prescription Drug Plan provides coverage for prescription drugs, period. That’s the basic difference between the two types of coverage.
People who enroll in a Medicare Advantage plan must have Medicare Part A and Part B. In this case, most people get their prescription drug benefits from the Medicare Advantage plan.
People who have Medicare Part A or Part B, and those who have both but prefer to stay in the federally administered traditional Medicare program, can get their prescription drug coverage from a standalone Medicare Part D Prescription Drug plan.
If you have Medicare Part A and Part B, a Medicare Advantage Prescription Drug plan may save you more in premium costs than a standalone Medicare Part D Prescription Drug Plan. Medicare Advantage plans tend to combine all their coverage under a single premium. This can be as low as $0 because you still pay your Medicare Part B premium.
A standalone Medicare Part D Prescription Drug Plan charges you a premium. If you get your Medicare benefits individually, your premium costs could add up. For example, you could be paying a:
- Medicare Part B premium,
- A Medicare Supplement plan premium,
- A Medicare Part D Prescription Drug Plan premium,
- A dental coverage premium, etc.
Common traits: Medicare Advantage Prescription Drug plans (Part C) and Medicare Part D Prescription Drug Plans
Medicare Advantage Prescription Drug plans (Part C) and stand-alone Medicare Part D Prescription Drug Plans are offered by private insurers approved by Medicare.
Each plan, whether a Medicare Advantage plan or not, has a formulary, or list of covered medications. All plans are required to cover all prescription drug classes but not necessarily all prescription drugs within each class. Formularies can change from time to time but those who are affected by a change are notified in advance. Formularies can differ from one plan to another.
Each plan, whether a Medicare Advantage plan or not, has cost-sharing features. These may be deductibles and copayments and coinsurance, or a combination of two or all three. A number of plans do not have an annual deductible.
Usually the amount you pay (copayment or coinsurance) is determined by the benefit tier your medication falls within and whether it is a generic prescription drug or a brand name one. Cost-sharing features can differ from one plan to another.
Each plan, whether a Medicare Advantage plan or not, has networks of contracted retail pharmacies. Most have mail order pharmacy arrangements, also. Plans can have different retail pharmacies in their networks.
Tips for evaluating potential Medicare Advantage plan (Part C) and Medicare Part D Plan prescription drug savings
- Make sure the medications you need are on the formulary (a list of covered prescription drugs) of the Medicare Advantage Plan (Part C) or standalone Medicare Part D Plan. A Medicare Advantage Plan (Part C) or Medicare Part D Prescription Drug plan usually won’t help pay for medicines that aren’t on its formulary, unless a special exception is granted.
Also, see what benefit tier your medication falls within to determine your cost. You may gain additional savings where the plan covers generic substitutes for brand-name medicines.
- Compare the costs. The premiums, deductibles, and copayments or coinsurance for Medicare Advantage Prescription Drug plans (Part C) and Medicare Part D plans differ from one plan to another.
- Check the pharmacies. If you are loyal to a particular pharmacy, see if it is in the directory. Does the Medicare Advantage plan (Part C) or stand-alone Medicare Part D Plan have preferred pharmacies? If so, you may get additional prescription drug savings using a preferred pharmacy.
Similarly, you may be able to save on prescription drug costs if the plan has a mail order pharmacy.
- Check to see if you qualify for Extra Help for Medicare Part D. Extra Help is an assistance program that helps lower income people more easily afford Medicare Part D). It helps pay for Part D premiums, deductibles, copayments and coinsurance when the person enrolls in a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Prescription Drug Plan.
Finding Medicare Advantage prescription drug plans and Medicare Prescription Drug Plans
Decide how you intend to receive your health benefits first. Then, the best way to save money on medications is to research and compare carefully Medicare Advantage Prescription Drug plans or stand-alone Medicare Prescription Drug plans in your area. You can do this by using the search plans tool on this page. You’ll be able to enter your medications to filter the choice of plans displayed.