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Will Medicare Advantage Cover Prescription Drugs?

Medicare Advantage (Medicare Part C) serves as an alternative for receiving Part A and Part B (Original Medicare) coverage. When you are first eligible for Medicare, you will likely enroll in Original Medicare first, but you can add on other coverage, such as a Medicare Advantage plan. Medicare Advantage plans are sold by private insurance companies with a contract with Medicare. Medicare Advantage plans must cover the same services as Medicare Part A and Part B. Thus, they combine the coverage from Part A and Part B.

Apart from covering the same services as Medicare Part A and Part B, they also offer certain benefits that are not covered under Original Medicare. Examples include prescription drug coverage, routine dental, vision, hearing, and more. To get prescription drug coverage, you can either sign up for Medicare Part D or enroll in a Medicare Advantage plan that offers the coverage. Unlike Original Medicare, Medicare Advantage plans limit how much you can spend out of pocket each year, making it a good alternative to Original Medicare for some.

Does Medicare Advantage Cover Prescription Drugs?

Many Medicare Advantage plans include drug coverage as part of their plan benefits. The list of covered medications under each Medicare Advantage plan is listed in the plan’s formulary. It is important to note that prescription drug coverage may vary between plans, so before enrolling, review the exact drug coverage provided by each plan.

There are specific Medicare Advantage plans that will provide prescription drug coverage, and some will have restrictions you must follow. Let’s take a look at those plans:

  • Health Maintenance Organization (HMO) Plans – Most HMO plans will provide prescription drug coverage. If you want to enroll in an HMO plan and have prescription drug coverage, you must enroll in an HMO plan that offers it.
  • Preferred Provider Organization (PPO) Plan – Most PPO plans will provide prescription drug coverage. To get drug coverage through a PPO plan, you must enroll in a plan that provides it. If you enroll in a PPO plan that doesn’t have prescription drug coverage, you cannot enroll in a Medicare Part D prescription drug plan.
  • Private Fee-for-Service (PFFS) Plan – Some PFFS plans may offer prescription drug coverage, but if you join a plan that doesn’t, you may be able to join a Part D plan.
  • Special Needs Plan (SNP) – All SNPs are required to provide prescription drug coverage.

Do You Need Prescription Drug Coverage?

At My Healthcare Direct, we make finding the right Medicare plan an easy process. We will help you compare your options and ensure you get the proper drug coverage you need. Call us today for more information!

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