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Medicare Advantage (Medicare Part C) plans combine Original Medicare benefits and possibly other benefits such as hearing, routine vision, and dental care into one comprehensive policy. Some plans will even include prescription drug coverage, which ultimately makes this called a Medicare Advantage Prescription Drug (MAPD) Plan. 

Let’s take a deeper dive into what a Medicare Advantage Prescription Drug Plan is.

Types of Medicare Advantage Prescription Drug Plans

There are several types of Medicare Advantage Prescription Drug plans which include: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs Plans (SNP), and Private Fee-For-Service (PFFS). Each of these Medicare Advantage plans has different rules regarding how you can receive coverage. For example, HMO plans require you to stay within its network of providers.

If you plan to get prescription drug coverage with your Medicare Advantage plan, you should sign up for an MAPD plan when possible. You will first become eligible for Medicare three months before your 65th birthday month. This starts your Initial Enrollment Period, which will then end three months after your birthday month. Once you are enrolled in Original Medicare, you can then go for an MAPD plan. 

While enrolled in Medicare Advantage, you should also take note of the Medicare Advantage Open Enrollment Period (January 1 – March 31) and the Annual Enrollment Period (October 15 – December 7). You can use these periods to make changes to your coverage and switch to new plans.

Now, suppose you are in a Medicare Advantage plan that doesn’t currently offer prescription drug coverage. In that case, you may be able to enroll in a standalone Part D plan. However, you will need to talk with your plan about this before you make any sudden decisions. In any case, you could just switch to an MAPD plan.

MAPD Plan Formulary

Each MAPD plan has a standard list of prescription drugs it covers called a formulary. Medicare Advantage Prescription Drug plans are generally required to offer two or more prescription drugs within each category.

However, before signing up for an MAPD plan, it is a good idea to ensure that all of your current prescriptions are covered in the plan’s formulary. Typically, something similar to the prescription you need will be available, but if you or your healthcare provider don’t think that anything else will work for your health condition, then an exception for your specific prescription could be made.

Need Help?

Please contact World Financial Solutions for more information about Medicare Advantage Prescription Drug Plans. Our experienced Medicare experts can guide you through all your Medicare options and help you choose the right plan for your needs.