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Medicare Advantage plans, also known as Medicare Part C plans, are an alternative way for Medicare recipients to get their Original Medicare (Medicare Part A and Part B) benefits. However, many Medicare Advantage plans also provide extra benefits, such as prescription drug coverage.

Prescription drug coverage is one of the benefits that most seniors require the most. Some Medicare Advantage plans bundle Original Medicare benefits and prescription drug coverage into a single plan called a Medicare Advantage Prescription Drug (MAPD) plan. 

Prescription Drug Coverage Under Medicare Advantage

Private insurance companies offer Medicare Advantage plans, which means the coverage varies between plans. Many Medicare Advantage plans will include prescription drug coverage, but not all will. This means you will have to consider your Medicare options carefully in order to get the coverage you’re wanting. Fortunately, with My Healthcare Direct, we can help you compare all your Medicare options, including those that include prescription drug coverage.

When it comes to MAPD plans and their coverage, they will have a formulary, which is the list of drugs covered by the plan. Each formulary must cover at least two drugs listed within each category and class. It’s important to compare your options, especially with this in mind, as your specific drug may not be covered by the plan you want, and your doctor may not approve an alternative drug option that is covered.

What Are The Types of Medicare Advantage Prescription Drug Plans?

There are several types of MAPD plans, and they include:

  • Preferred Provider Organization (PPO)
  • Health Maintenance Organization (HMO)
  • Private Fee-For-Service (PFFS)
  • Special Needs Plans (SNP)

However, while there will more often than not be prescription drug coverage included with these plans, that’s not always the case. These plans are not required to offer prescription drug coverage, except for Special Needs Plans. But, these Special Needs Plans have very specific requirements you must meet to enroll in one. If you do not meet their criteria, you will have to stick with one of the other Advantage plans listed above, as long as one is available in your area.

Qualification For MAPD Plans

To enroll in a Medicare Advantage Prescription Drug plan, you must be enrolled in Original Medicare and live within the plan’s service area.

You first qualify to enroll in a Medicare Advantage plan during the Initial Enrollment Period, which is a 7-month period that starts three months before your 65th birthday month and ends three months after your birthday month. Another popular enrollment period is the Annual Enrollment Period (October 15th to December 7th). You can make changes to your coverage during this period, including going from Original Medicare to a Medicare Advantage Prescription Drug Plan.

Do you have questions about Medicare Advantage Prescription Drug plans? Contact My Healthcare Direct to have any of our licensed experts answer your Medicare-related questions.

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