Prescription Benefits in Medicare Advantage

Though Original Medicare provides significant health insurance benefits, it can be accentuated with other, private plans designed to offer expanded coverage. One of these is Medicare Advantage coverage, often called Medicare Part C.

Medicare Advantage is private insurance that offers the same benefits of Original Medicare, but also includes other coverage. Usually, prescription drug insurance is among this additional coverage. It will enable you to get both your medical and prescription benefits in one place, both with exceptional cost management opportunities. a laptop computer sitting on top of a table

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What’s a Medicare Advantage Plan

The United States government’s Medicare program is founded on two benefits: Part A (hospital coverage) and Part B (medical coverage). However, though these plans go a long way towards reducing health care costs for seniors and others, they aren’t all-encompassing. As a result, the private insurance market has stepped in to fill the gap through regulated, Medicare-approved plans like Medicare Advantage benefits.

Part C plans essentially offer all of the same benefits as Original Medicare. Their cost structures, physician networks and other factors might vary from Original coverage, though they still must meet minimum standards. Additionally, they will offer benefits like dental, vision and prescription insurance.

Since Original Medicare doesn’t cover basic prescriptions on its own, the choice to enroll in Medicare Advantage on top of your Original coverage will ensure that you have coverage available when you need to will ensure you are able to afford your medications if and when you need to take them.

Prescription Coverage Under Medicare Part C

Even though they are private policies (offered by numerous private insurers), Medicare Advantage policies still differ among themselves. However, Medicare regulations also require that all Advantage plans meet certain standards.

Usually, you’ll find that your coverage includes some of the following terms:

Each plan will include a formulary that lists and explains which prescription drugs it will cover. Usually, the plan will offer at least two choices of the same type of medications. For example, you’ll usually be able to choose between two blood pressure medications, and so on. These formularies can change.
Plans will separate drugs into tiers. The most-expensive drugs will go into the highest tiers.
Depending on your plan, your out-of-pocket costs for drugs will vary. Two plans might cover the same drug, but the costs might vary between plans. Costs might also vary from drug to drug within the same tier.

When setting up your Medicare Advantage benefits, speak with your insurer about how your particular prescription benefits work. They can help you understand how to check which drugs are covered, the process for filling prescriptions and your cost obligations. They can also help you choose a plan that will offer you the most appropriate premium for your needs.

Prescription Benefits in Medicare Advantage

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