Medicare Advantage and Part D Drug Plans

Medicare Advantage Plans

Medicare Insurance PlansMedicare Advantage Plans (also known as Medicare Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include Medicare Part D prescription drug coverage, or you may be able to enroll in a separate Prescription Drug Plan depending on which type of Medicare Advantage plan you enroll in.. Medicare Advantage Plans include:

  • Medicare Health Maintenance Organization (HMOs)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service (PFFS) Plans
  • Medicare Special Needs Plans (SNP)
  • Medicare Medical Savings Accounts (MSA)

Please refer to the Centers for Medicare and Medicaid Services Booklet for a complete outline of the Medicare Advantage Program.

Part D: Prescription Plans

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are able to choose not to cover some drugs at all. he exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.

It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid will pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.