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Medicare Advantage & PDP

Medicare Advantage

Medicare Advantage (MA) plans, alternatively known as Medicare Part C, are comprehensive healthcare plans offered by private insurance companies approved by Medicare. These insurance plans combine the benefits of Medicare Part A, i.e., hospital insurance, and Part B, i.e., medical insurance, often including additional benefits like vision, dental, and wellness programs.

Eligibility

  • One must be enrolled in both Medicare Part A and Part B.
  • Most plans require you to live in the plan’s service area.
  • Those with end-stage renal disease (ESRD) may have limited options but can still qualify under certain circumstances.

Coverage

  • Hospital stays (Part A coverage)
  • Medical services (Part B coverage)
  • Prescription drug coverage (often included in MA plans)
  • Additional benefits like vision, dental, hearing, and wellness programs

Prescription Drug Plans (PDP):

Prescription Drug Plans (PDP) are standalone plans that provide coverage for prescription drugs; these plans work in parallel to Original Medicare (Parts A and B) to help cover the costs of medications.

Eligibility:

  • Individuals must be enrolled in Medicare Part A or Part B.
  • Those with a Medicare Advantage plan (Part C) that doesn’t include prescription drug coverage will need a separate PDP.

Coverage

  • Various tiers of coverage for different types of drugs (generic, brand-name, specialty)
  • Access to a network of pharmacies where you can fill your prescriptions
  • Financial assistance to reduce out-of-pocket costs for medications
  • Mail-order options for convenience and potential cost savings

Frequently Asked Questions (FAQs)

Learn more about Medicare Advantage and PDP with our FAQs. We're here to clarify and help you make informed decisions about your healthcare coverage.

Medicare Advantage plans offer several advantages over Original Medicare (Parts A and B). The main benefit is that MA plans often provide additional coverage beyond what Original Medicare offers. This can include prescription drug coverage, vision, dental, hearing, and wellness programs. Moreover, MA plans usually have an out-of-pocket maximum, limiting your annual healthcare costs and providing financial predictability.
A Prescription Drug Plan (PDP) is a standalone plan that helps cover the costs of prescription medications. These plans vary in the specific drugs covered, deductibles, copayments, and coinsurance amounts. PDPs have a formulary a list of covered drugs, and may offer tiered pricing based on the drug's category and generic or brand status.
Generally, you cannot have a Medicare Advantage plan and a separate PDP simultaneously. Most Medicare Advantage plans come together with prescription drug coverage (Part D). If you opt for a Medicare Advantage plan with drug coverage, you will be automatically dis-enrolled from any standalone PDP to avoid duplicating drug benefits. However, if your Medicare Advantage plan doesn't include drug coverage, you can register in a standalone PDP.
To get more information about Medicare Advantage, please Click Here.
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