Can I Get Prescription Drug Coverage Through Medicare Advantage?

Medicare Advantage plans are an optional way to receive Medicare Part A and Part B coverage. These plans are also referred to as MA or Part C plans. Private companies provide this additional coverage to the consumer.

There are 4 common types of Medicare Advantage plans. These include Preferred Provider Organization (PPO) Plans, Health Maintenance Organization (HMO) Plans, Private Fee-For-Service Plans (PFFS) and Special Needs Plans.

Most Medicare Advantage plans provide prescription drug coverage, but not all of them do. Keep reading below so that you can make your best decision regarding Medicare Advantage.

Preferred Provider Organization (PPO)

These plans have network hospitals, doctors and additional healthcare providers. If you use this network, you will generally pay less but you do have the option of going outside these networks to receive your care. You will pay more if you go outside of the network.

Prescription drugs are covered through most PPO plans. With Medicare Detectives, we can help you compare your PPO plan options to determine which plan provides the prescription drug coverage you need.

Health Maintenance Organization (HMO)

For the most part, with a Health Maintenance Organization, you must use in-network hospitals, doctors or other healthcare services. There are some exceptions such as emergencies, out-of-area urgent care and out-of-area dialysis. There are other times that you may go out-of-network, but this is up to the insurance provider. Your services will cost less if you stay in-network.

In most cases, prescriptions are covered in Health Maintenance (HMO) plans. Please check with your insurance provider to be sure. If you are interested in Medicare Part D (Medicare Drug Coverage), you must have an HMO plan that offers prescription drug coverage.

Private Fee-For-Service Plans (PFFS)

Private Fee-For-Service Plans calculate how much they will pay hospitals, doctors and other healthcare services. In addition, they will determine how much you will pay as well. Since these plans are provided, their services can vary. Many of them have in-network doctors and hospitals. You will usually pay less if you use these providers.

In some cases, prescription drugs are covered by Private Fee-For-Service Plans. Please check with your individual insurance company to be sure of their coverage. If the company does not offer a prescription drug plan, you can obtain a Medicare Drug Plan (Part D).

Special Needs Plans

Special Needs Plans are very similar to an HMO or a PPO. These plans are only offered to individuals with very specific diseases and needs. Companies tend to offer these plans with special provider choices, benefits and drug options. Most of the time, you must receive your care through In-Network Providers. There are some exceptions such as urgent or emergency care.

All Special Needs Plans are required to provide prescription drug coverage.

Give Medicare Detectives A Call Today!

At Medicare Detectives, providing quality service to our customers is our top priority, and that means getting you the coverage you deserve. We work hard to make sure you understand all your Medicare Advantage options so you can make the best decision on your healthcare.