Medicare Advantage plans, also known as Medicare Part C plans, are provided by private insurance companies approved by Medicare. Medicare Advantage plans provide coverage for all the services offered by Original Medicare, as well as other healthcare benefits such as prescription drug coverage. Medicare Part C covers different prescription drug types, helping you save money on your medications and reduce out-of-pocket costs.

Prescription Drug Coverage Under Medicare Advantage

Private health insurance companies manage Medicare Advantage plans, so the benefits vary between plans. However, many of the plans cover prescription drugs. When you register for a Medicare Part C plan, the private health insurance company will provide a formulary. The formulary lists the medications that are covered under the beneficiary’s plan.

The formulary is required by Medicare to cover different tiers of drugs. Each formulary must contain at least 2 drugs in the most common medication categories, such as blood pressure and diabetes medications.  

• Usually, generic drugs are the lowest-cost drugs, and they serve as the alternative to brand-name drugs. You can find most of the generic drugs in the formulary Tier 1, and this has the lowest copayment.
• Tier 2 medications have an average copayment and mostly include brand-name drugs and a couple of generic drugs.
• Tier 3 drugs have a higher copayment, which includes both brand name and generic prescription drugs.
• Specialty-tier drugs are the ones that have a higher cost, so you pay the highest copayment.

The insurer will have to approve all the medications listed on the Medicare Advantage plan’s formulary, and each plan will vary according to how the drugs are organized on their formulary. Before you enroll for Medicare Part C, you should review the formulary of the plan. While you may not find a formulary that contains all the drugs you require, opting for a Medicare Advantage plan that has the most coverage can save you money.

Finding a Medicare Advantage Plan with Prescription Drug Coverage

There are several ways to find Medicare Advantage plans with prescription drug coverage. If you qualify for a Medicare Advantage Special Needs Plan, these plans are required to provide prescription drug coverage.

Choosing a plan with prescription drug coverage can be challenging at a glance, but iHealthcare Direct can help you compare every Medicare Advantage plan available in your area. Our experienced Medicare experts can filter the available options according to your needs and then evaluate them side by side.

Contact iHealthcare Direct today for any Medicare-related questions and assistance about Medicare Advantage and prescription drug coverage.

Medicare Supplement Plans, also referred to as Medigap, are not stand-alone Medicare Plans. They fill in the gaps in the Original Medicare Plan where the plan’s coverage stops. These plans are provided by private insurance companies, but they are approved by Medicare.

Original Medicare and Medigap

Original Medicare is composed of two of the four parts of Medicare: Part A and Part B. Medicare Part A is considered “hospital insurance,” while Medicare Part B is considered more along the lines of actual “health insurance,” since it covers sick visits and preventative services. 

Once you enroll in the Original Medicare Plan, you’re eligible to enroll in a Medicare Supplement Plan or Medigap. Enrolling in one of these supplement plans does not replace your Original Medicare Plan — it simply helps reduce your out-of-pocket costs that are caused by what is not covered under Original Medicare. 

Medigap assists with deductibles, copayments, and coinsurance costs. Some of the Medigap plans that are offered also offer coverage for things that Original Medicare would not, such as medical care when traveling outside the United States. 

Medicare Advantage and Medigap

You cannot be enrolled in a Medicare Advantage Plan and a Medigap Plan at the same time. You’re only eligible for a Medigap Plan if you have both Parts A and B. Medicare Advantage Plans, also known as Medicare Part C, provide and usually exceed the benefits offered by Original Medicare. 

Medigap fills in for Original Medicare; Medicare Advantage Plans not only provide hospital and medical coverage, but they also typically offer prescription drug coverage, as well as vision, dental, and hearing benefits. Some even offer transportation to and from the doctor and a free or discounted gym membership.

One advantage of being enrolled in Original Medicare and a Medicare Supplement Plan, though, is that you’re eligible to receive treatment anywhere across the United States, as long as they accept Medicare. When enrolled in a Medicare Advantage Plan, you typically enroll in either an HMO (Health Maintenance Organization plan) or a PPO (Preferred Provider Organization plan). 

HMOs and PPOs have in-network providers that they prefer you to choose from. If you decide to seek out-of-network treatment, then you’ll pay more out-of-pocket, and may not receive any aid from your Medicare Advantage Plan at all. However, a PPO plan is a bit more lenient than HMO.

Important Facts To Know About Medigap Policies

Remember, in order to enroll in a Medicare Supplement Plan, you must first enroll in Medicare Parts A and B, aka Original Medicare. Medicare Supplement Plans and Medicare Advantage Plans are not the same types of plans. 

• Medigap helps fill the gaps to ease your out-of-pocket costs. 
• Medicare Advantage Plans actually provide full health insurance coverage once enrolled. 

You may also be required to pay a monthly premium for your Medigap Plan. If so, you’re still responsible for paying the Medicare Part B monthly premium as well. As of 2006, Medigap plans cannot cover prescription medications, so you must purchase a separate Medicare Part D drug coverage plan. You’re also responsible for that premium, although some people qualify for the Extra Help program. 

Want to Learn More? Reach Out Today

At iHealthcare, we care about providing you with as much information as possible about your Medicare options. If you’re interested in a Medicare Supplement Plan and would like to learn more about the coverage involved with a Medicare Supplement, give us a call today. We’re here to help!

Medicare Advantage is a type of policy that exists within Medicare. These policies are offered through private insurance companies and allow individuals to add additional coverage areas to their policies that would not otherwise be available with Original Medicare.

There are a few different policy choices within Medicare Advantage. One of the important things to note is that they offer network coverage. How strict the policy is about seeking care within the network is the biggest differentiator between the different types of plans. Let’s discuss the differences between HMO policies and PPO policies.

HMO

Health Maintenance Organization (HMO) plans are the stricter option when it comes to selecting policies. They typically will only cover care if it’s within their provider network, but there are a few exceptions to this. Another defining feature of this type of policy is that it does require beneficiaries to select a primary care doctor. One of the reasons for this is that HMOs do require beneficiaries to get a referral to receive care from a specialist. The primary care doctor that’s chosen can also be helpful when keeping track of health and acting as the first line of contact in some medical situations.

HMO policies are an excellent choice if you’re confident that you’ll only ever be receiving care within the network. If you’re looking for a more flexible option, then consider if a PPO could be the right choice for you.

PPO

Preferred Provider Organization (PPO) plans are a good alternative to HMOs. They will cover care that’s received outside of the network, although you will have to pay more out-of-pocket if you do receive care outside of a network. This type of policy does not require beneficiaries to choose a primary care doctor, as it also does not require referrals to see a specialist.

Which policy is the right choice for you?

When it comes to selecting the right policy, there are so many different variables that can come into play. It can be helpful to take a look at the network in your area to get an idea of the providers that you may be receiving care from. Making sure that you’re comfortable with this list is an important step in selecting the right policy.

If you’re looking for a policy that will provide you with flexibility, then consider if a PPO could be the right choice for you. However, if you’d prefer to know how much of your care will be covered, then an HMO policy might be the best choice for you.

Regardless of the policy that you choose, being able to see the differences between them is essential. If you’re just beginning the research process, it can be helpful to reach out to an insurance agent. At iHealthcare, we’re here to make this process easier for you, so let our team help you get on the right path to finding Medicare Advantage coverage that works for you.