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What is a Medicare Advantage Prescription Drug Plan?

Medicare Advantage is also called Medicare Part C. It covers everything that is covered under Original Medicare in addition to certain services not covered by Original Medicare. One of these added benefits is prescription drug coverage. This means you can get coverage for prescription drugs through a specific Medicare Advantage plan instead of enrolling in Medicare Part D. 

A Medicare Advantage Prescription Drug plan combines the health insurance benefits and prescription drug coverage into one plan. Like other Medicare Advantage plans, Medicare Advantage Prescription Drug plans cover everything that Medicare Part A and Part B cover. Some MA PD plans may also cover routine dental, vision, and wellness programs.

Types of Medicare Advantage Prescription Drug Plans

There are different types of Medicare Advantage plans that offer prescription drug coverage, but only one plan is guaranteed and required to provide this coverage. This plan is known as the Special Needs Plan.

Special Needs Plans are tailored to people who meet certain criteria, such as people who have chronic conditions or people who have both Medicare and Medicaid coverage. SNPs cover prescription medications that are tailored to meet the healthcare needs of the beneficiaries.

Medicare Advantage Prescription Drug Plan Formulary

Like Medicare Part D, each Part C plan that covers prescription drugs has a plan formulary. The plan formulary is a list of prescription drugs covered by the plan. Each Medicare Advantage Prescription Drug plan must cover at least two medications within each category, as well as most, if not all of the medications that fall under categories such as antidepressants, immunosuppressants, antipsychotics, anticancer, etc. 

The medications covered are divided into tiers that determine the cost. Generic drugs are placed in a lower tier, while brand name and specialty medications are placed in higher tiers. Before you enroll in a Medicare Advantage Prescription Drug plan, ensure the plan covers the prescription medications you need. The cost may also vary from plan to plan.

Eligibility and Enrollment

To enroll in a Medicare Advantage Prescription Drug plan, you must have Medicare Part A and Part B. You must also live within the plan’s service area. 

Some of the most common enrollment periods to take note of to enroll in a plan like this is the Medicare Advantage Open Enrollment Period, Annual Enrollment Period, and even a Special Enrollment Period.

To know more about Medicare Advantage plans and how to get prescription drug coverage, reach out today by giving us a call at 316-260-331.