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Should I Get Medicare Part D Coverage Through Medicare Advantage or a Stand-Alone Plan?


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Are you thinking about Medicare Part D coverage for your prescription drugs? As you may know, there are two main ways to get this coverage:

  • Stand-alone Medicare Part D Prescription Drug Plan
  • Medicare Advantage Prescription Drug plan

We’ll walk through the differences and similarities of each, and how they may or may not fit your situation.

Medicare Part D coverage options: stand-alone

Of the nearly 44 million people who have Medicare Part D coverage, about 58% are enrolled in stand-alone Medicare Part D Prescription Drug Plans, according to the Centers for Medicare & Medicaid Services.

What makes these plans “stand alone?” This type of plan doesn’t “stand” completely alone, as it works alongside your Original Medicare (Part A and/or Part B) coverage. But the other type of Medicare Part D coverage is folded into another type of plan (Medicare Advantage), which we’ll explain below.

Medicare Part D coverage options: Medicare Advantage

The Medicare Advantage (Part C) program offers you an alternative path to your Medicare benefits. With a Medicare Advantage plan, your Original Medicare (Part A and Part B) benefits are administered to you by a private, Medicare-approved insurance company. You’re still in the Medicare program, even though the plan is handling your benefits for you.

Most Medicare Advantage plans have Medicare Part D coverage built into their benefits. They’re sometimes referred to as Medicare Advantage Prescription Drug plans.

Medicare Part D coverage options: what do they have in common?

Both types of Medicare Part D coverage:

  • Are available from private insurance companies that contract with Medicare
  • Require that you live within the plan’s service area
  • Require that you enroll in Original Medicare, but the stand-alone plans only require you to have Part A or Part B (or both). Medicare Advantage plans require you to have both.
  • Have formularies (lists of covered prescription drugs). Formularies can differ among plans, so you’ll want to make sure the plan you choose covers your medications. Plans can change their formularies at any time, but you will receive notice when necessary.

Medicare Part D coverage options: which one might suit your needs?

Only you can decide what works for you. Here are some questions and answers to get you thinking about the type of Medicare Part D coverage that may be the one for you.

Do you have a favorite doctor, specialist, clinic, or other provider?

 

 

 

 

 

 

You might want to stay with Original Medicare and a stand-alone Medicare Part D Prescription Drug Plan. You can see any doctor that accepts Medicare assignment.

Some Medicare Advantage plans have provider networks. You might have to get care within the network, or pay more if you go out-of-network. In some cases you might not be covered at all if you go out-of-network.

Are you on a limited budget, and fairly healthy?

 

You might like to know that some Medicare Advantage plans have premiums as low as $0. However, plans may have other costs (such as copayments and deductibles), so compare plans carefully.
Do you go to the doctor often? Do you have a health condition that might require hospitalization – now or down the road?

 

 

 

 

 

 

A Medicare Supplement insurance plan might be a good option for you. All standardized Medicare Supplement plans (in 47 states) typically cover your hospital costs for up to a year after Medicare benefits are exhausted. And remember, each visit to a doctor usually requires a 20% coinsurance payment under Medicare Part B, but most Medicare Supplement plans pay this coinsurance.

Medicare Supplement plans do have monthly premiums.

Do you want the convenience of having all your Medicare coverage in a single plan? Medicare Advantage Prescription Drug plans provide your Medicare Part A, Part B, and Part D benefits in one plan.

 

Now that you’ve thought about the points of both types of plans that includes Medicare Part D coverage, maybe you’d like to compare some Medicare Part D Prescription Drug Plans. Just enter your ZIP code in the box on this page and follow the prompts. You can enter your prescription drugs while viewing plans, and get into a detailed comparison.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

The product and service descriptions, if any, provided on these eHealthInsurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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