Some Medicare Advantage policies offer prescription drug coverage, solidifying Medicare Advantage’s status as the most inclusive of all Medicare policies.
Medicare Advantage vs. Medicare Part D
Medicare Part D alone has a $445 maximum deductible in 2021, with a premium averaging $33.06 and a potential for a late enrollment fee if you have missed your chance to join when it was first available to you. In both Florida and Alabama, roughly one-third of both state’s Medicare beneficiaries have a standalone Part D plan.
Medicare Advantage circumvents the inconveniences mentioned above. You can join Medicare Advantage at any point during the time you’re enrolled in Medicare, with no late fees no matter how long you wait. Medicare Advantage premiums are often $0, although some can have a monthly cost of $21.
Extra benefits, extra access
One of Medicare Advantage’s best features is the ability to get discounted dental and vision care. Someone who has an insurance policy that doesn’t cover either of these (e.g. Original Medicare) may decide not to get treatment.
But one overlooked feature is that Medicare Advantage enables policyholders to get these treatments without hesitation because the fear of paying too much out-of-pocket is gone. Dentists and optometrists prescribe medications, too. Medicare Advantage’s coverage indirectly gives you access to prescription medications you wouldn’t have gotten with just Medicare Part D. In fact, about 44 percent of Alabama’s Medicare beneficiaries have a Medicare Advantage plan with Part D coverage. In Florida, about 4.6 million people are enrolled in Medicare, but nearly half of these beneficiaries are enrolled in Medicare Advantage.
Plans with prescription coverage
Medicare Advantage is made up of different policies, each with its own rules about getting coverage out-of-network, the need to select a primary care physician and getting that physician’s referral when seeing specialists, and prescription drug coverage.
The plans covering prescription drugs include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP)
For HMOs and PPOs, prescription drug coverage is a given in most cases. However, prescription drug coverage isn’t guaranteed in PFFS plans, although many PFFS plans do cover prescriptions. SNPs, no matter what health insurance provider you get them from, are legally required to have prescription drug coverage.
Medications covered
Each plan has its own formulary or list of prescription drugs the plan covers. That’s why it’s a good idea to let your insurer know what medications you’re taking so that you can get the Medicare Advantage plan with the drug coverage that’s right for you. But there are certain medications that every formulary must include the protected classes – anti-cancer and HIV/AIDS drugs in particular.
Questions? Call Sunsurance Agency
At Sunsurance Agency, we understand the needs of our customers. For your prescription needs, we’ve got you covered. We operate in Alabama (Dothan and Enterprise) and Florida (Pensacola, Tallahassee, and Pace), providing top-quality service for each location. Call us today at 334-441-3905.