Getting Part D With A Medicare Advantage Plan

Does it make sense for you to get Part D through a Medicare Advantage plan?

If you are new to Medicare it helps to know the ins and outs of getting your Part D through a Medicare Advantage plan. Watch the following video to learn about the types of plans available and the pros and cons of getting your Part D in this way.

The difference between a MAPD and a MA and why it matters when getting Part D

There are two ways to get your Part D benefits.

  • Enroll in a stand-alone Part D plan
  • Enroll in a Medicare Advantage plan which includes Part D

But let’s not get ahead of ourselves. Not all Medicare Advantage plans include Part D. Only a plan deemed a MAPD includes Part D. A MA plan is medical only.

With a MAPD you have comprehensive coverage, including:

  • Part A
  • Part B
  • Part D

There are several types of Medicare Advantage plans, including:

  • PPO
  • HMO
  • HMO-POS
  • PFFS

When enrolled in a PPO you will be able to receive services out of the preferred provider network but will pay more for services.

A HMO or Health Maintenance Organization will require that you receive all services from network providers. Out-of-pocket costs are often lowest with this type of plan.

A HMO-POS (Point of Service) has features of both a PPO and HMO and affords you a little more flexibility than a HMO.

A Private Fee-For-Service plan allows you to choose any provider that accepts the plan’s payment terms and conditions. It’s important to note that providers can choose to accept the plan on a visit by visit basis.

You cannot add a stand-alone Part D plan to:

  • PPO
  • HMO
  • HMO-POS

You can only add a stand-alone plan to a Private Fee-For-Service plan.

Pros and cons of receiving Part D through a Medicare Advantage plan

Pros

Many people like the all-in-one convenience of receiving their Medical and drug benefits all in one plan.

When you receive your Medicare benefits this way you will not pay a separate Part D premium and if you enroll in a MAPD with a $0 premium you will receive your drug coverage without a premium as well.

Cons

Getting your Part D within a Medicare Advantage plan may complicate comparing and shopping for a plan. You have more moving parts to consider.

For example, you may find the medical benefits ideal only to be let down by the drug coverage.

Most MAPD plans include a basic Part D formulary. This can limit options for someone who requires an enhanced formulary to ensure that all their medications are covered.

Important documents when comparing plans

When comparing MAPD plans, you should review the following plan documents:

  • Summary of Benefits
  • Provider Directory
  • Part D Formulary

Getting your Part D benefits through a Medicare Advantage plan can be a good option if you know the rules and can find a plan that will include all of your medications.

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