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Comparing Stand-Alone Medicare Prescription Drug Plans VS Medicare Advantage Plans

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Summary: If you have Medicare Advantage, your prescription drugs may be conveniently bundled in with your medical and hospital insurance. If you have Original Medicare, you may enroll in a stand-alone Medicare prescription drug plan. Medicare prescription drug coverage could save you money at the pharmacy.

If you’re like many people on Medicare, you take at least one prescription drug daily. However, basic Medicare doesn’t cover most prescription drugs you take at home. Medicare has contracted with private insurance companies to provide prescription drug coverage to Medicare beneficiaries, usually at an additional cost.

Medicare prescription drug plans are called Medicare Part D. You think of “D” for “drug.” The good news is that you have options for how you want your Medicare prescription drug coverage.

Medicare Advantage Plans vs stand-alone Medicare prescription drug plans

You can choose to get your Medicare benefits through Original Medicare. Alternatively, you might decide you would prefer to enroll in Medicare Advantage. If you have Medicare Advantage, your prescription drugs may be conveniently bundled in with your medical and hospital insurance and you don’t need any additional coverage. However, if you have Original Medicare, you may enroll in a stand-alone Medicare prescription drug plan.

Otherwise, some of you may be able to satisfy Medicare’s requirement for creditable prescription drug coverage through a retirement or government health plan.

Medicare Advantage plans with bundled Part D coverage

You may decide you’d prefer the convenience of Medicare Advantage plans that come bundled with prescription drug insurance. You will pay the same monthly premium for both your health and prescription drug plan. So, the main advantage of having Medicare Advantage plans with prescription drug coverage is that it simplifies managing your healthcare.

In a Medicare Advantage plan:

  • Most plan members enroll in a Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), so you may also need to consider the network of pharmacies to make a decision. You want to be certain you can access convenient pharmacies.
  • In addition, each plan may have its own list of covered and preferred prescription drugs, so you should definitely check the drug tier of any prescriptions that you already have. Just as with stand-alone Medicare prescription drug plans, Medicare Advantage plans call this list of covered medications a formulary.
  • Of course, you can switch either stand-alone prescription drug plans or Medicare Advantage plans during Fall Open Enrollment from October 15 through December 7 of every year. That means you aren’t locked into a choice forever.

Benefits of stand-alone Part D plans

On the other hand, some Medicare beneficiaries prefer to manage their health and prescription drug coverage independently. With a stand-alone Medicare prescription drug plans you can consider the prescription drug formulary and network of pharmacies independently of the medical benefits and network of your other health insurance.

Having the chance to shop for the right stand-alone prescription drug policy could save you money at the pharmacy on expensive prescription drugs.

For instance:

  • Let’s say you want the flexibility of a national PPO to get covered at both network and non-network drugstores. With Medicare Advantage plans, you’d also need a medical PPO.
  • Some of you may already have medical benefits from a type of insurance that doesn’t include medication. In that case, you’ll certainly want to consider stand-alone Part D over Medicare Advantage plans with prescription drug coverage.

Medicare Advantage Plans vs Part D

Medicare Advantage plans can do a great job of controlling costs and simplifying claims. When Medicare Advantage plans include Part D, you can simply use the same ID card at the pharmacy that you use at the doctor. If you like this sort of convenience and are happy with both the prescription drug and medical networks, consider Medicare Advantage plans that come with Part D. Still, Medicare Advantage plans with prescription drug insurance might not be the best solution for everybody, so it’s important to understand your options.

To find a Medicare Advantage or stand-alone Medicare Part D prescription drug plan in your area, enter your ZIP Code on this page.

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