What is a Medicare Advantage Plan?
Medicare offers prescription drug coverage to everyone with Medicare through what's referred to as Part D. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you're first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you'll likely pay a late enrollment penalty when you do sign up, unless you have other creditable prescription drug coverage, or you get Extra Help.
That's a long and complicated way of saying, you should consider participating in a Part D plan whether you're signing up for Original Medicare, Medical Supplemental or a Medicare Advantage plan.
To get Medicare drug coverage, you must join a prescription drug plan run by an insurance company or other private insurance company approved by Medicare. Each plan will vary in cost and drugs covered.
2 ways to get prescription drug coverage:
Method 1: Medicare Prescription Drug Plans, Part D plans (sometimes called "PDPs"), add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Method 2: Medicare Advantage Plans (Part C) (like an HMO or PPO) are like other Medicare health plans in-that they offer Medicare prescription drug coverage as part of the plan. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, as well as prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
What Drug Plans Cover:
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on these formularies. Drugs in each different tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
Provide written notice to you at least 60 days prior to the date the change becomes effective.
At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.
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