If you’re new to Medicare, you may not know that there are two distinct ways to get prescription drug coverage: through original Medicare (Part A, Part B, and the addition of a Part D plan for prescription coverage), or through an all-in-one comprehensive Medicare Advantage (MA) plan, which typically includes prescription drug coverage not covered by Parts A or B.

With Medicare prescription drug plans being rolled into Medicare Advantage (Part C) plans, we highly recommend this option to our patients. Not only does this make getting prescription drug coverage easier and more streamlined, but it also gives you more choices when finding the perfectly-tailored plan. 

With so many options available, it can be difficult to choose the right plan that suits your needs. In this article, we’ve compiled a list of commonly asked questions about Medicare Advantage prescription drug plan benefits to help you better navigate your plan choices. 

Do all Medicare Advantage plans come with prescription drug coverage?

Usually the answer is yes, as long as you enroll in an HMO or PPO plan. However, there are some exceptions, so be sure to review your plan options carefully with the in-office representative. 

What about Special Needs Plans? Are prescription drugs covered in those too?

Yes, and this is a huge advantage of Special Needs Plans (SNPs). It’s mandatory for SNPs to to include prescription drug coverage since one of the goals of an SNP is to keep medical coverage affordable for seniors with the greatest needs.

There are three distinct types of SNPs that you may qualify for: 

  • Chronic Condition SNP (C-SNPs): These are applicable for Medicare beneficiaries who have certain chronic health conditions.
  • Dual Eligible SNP (D-SNPs): An income-based consideration, these SNPs are intended for people who qualify for both Medicare and Medicaid. 
  • Institutional (I-SNPs): These SNPs come into effect if you require long-term specialized caretaking at home or care in a medical facility.

If you aren’t sure whether you qualify for a SNP, give us a call at (352) 795-0644 to get assistance from our in-office representative.

What benefits come with Medicare Advantage prescription drug plans?

Medicare prescription drug plans offer varying levels of coverage for different types of medications, but they generally cover a range of brand-name and generic prescription drugs. Medicare drug plans typically include coverage for certain vaccines as well, such as the flu shot or the shingles vaccine. It’s worth noting that each plan has its own formulary, which is a list of covered drugs, so it’s important to review a plan’s formulary to find whether the medications you need are covered. Additionally, some plans have restrictions on the quantity or dosage of drugs they will cover, and may require you to get prior authorization before certain medications are covered.

Do Medicare Advantage plans cover insulin?

In 2021, Medicare implemented a new policy to cap the monthly out-of-pocket cost of insulin for Medicare beneficiaries enrolled in most Medicare plans. This cap is set at $35 for a 30-day supply of insulin, regardless of the type of insulin or how much is needed. This policy applies to Medicare Part D prescription drug plans and Medicare Advantage plans that include prescription drug coverage. The policy is designed to provide financial relief to Medicare beneficiaries who rely on insulin to manage their diabetes, particularly those who may struggle with the high cost of insulin.

It’s important to note that this policy does not apply to all Medicare beneficiaries, as some may be enrolled in plans that are exempt. However, for those who qualify, this policy may help make insulin more affordable and accessible.

What costs are associated with Medicare Advantage prescription drug plans? 

The amount you pay in deductibles and copays for Medicare Advantage will vary depending on the plan you choose and where you live. That said, MA plans typically cap your total out-of-pocket costs. According to the Medicare website, “No Medicare drug plan may have a deductible more than $505 in 2023. Some Medicare drug plans don’t have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.”

How do I know which plan is right for me?

While we strongly recommend Medicare Advantage plans since we have seen how well they work for our patients, we understand that you may have some lingering questions about your options for Medicare prescription drug plans. One helpful Medicare resource is their blog post, 6 Tips for Choosing Medicare drug coverage, or you can check out our blog post, A Quick Guide to Enrolling in a Medicare Part D Prescription Drug Plan. 

Ultimately, there are many factors to consider when selecting a plan that meets your unique needs, so please remember that Meadowcrest Family Physicians is always here to help. You can reach out to us any time to schedule an appointment with our in-office representative who is here to answer your questions and help you explore your options.