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Medicare Advantage Plans and Coverage for Prescription Drugs

Medicare Advantage Plans and Coverage for Prescription Drugs

Many participants choose to receive their Medicare benefits from a private company that offers Medicare Advantage plans (sometimes called Medicare Part C). Medicare Advantage plans provide all of the benefits of Medicare Part A (hospital coverage) and Medicare Part B (doctors and other medical service provider coverage).

When prescription drug benefits were added to Medicare in 2006, many private insurance companies began to offer Medicare Advantage plans that provide prescription drug benefits (sometimes called Medicare Part D).

Today it is common to find Medicare Advantage plans that include both medical coverage and prescription drug coverage, known as a Medicare Advantage-Prescription Drug Plan (MA-PD). It is important to note that nearly all MA-PD plans have a pharmacy network for filling prescriptions.

Here is a quick look at the basics of the drug coverage of MA-PD plans.

Prescription drug benefits and MA-PD plan structure

Prescription drug coverage on most MA-PD plans requires enrollees to use pharmacies in the plan's network. Typically, if a prescription is filled by a non-network pharmacy, it will not be covered by the plan.

Additionally, MA-PD plans will most likely have cost-sharing tiers for different types of medications. Participants will likely pay different copayment or coinsurance amounts for drugs in each tier. For example, the copayment could be $5 for a generic drug, $25 for a preferred BCBSGA drug, and $40 for a non-preferred BCBSGA drug. Alternatively, the copayment could be a percentage of the cost (coinsurance).

Considerations when choosing an MA-PD plan

If you are considering a Medicare Advantage plan, you should understand the following:

  • First, verify whether or not your Medicare Advantage plan also includes prescription drug coverage.
  • Confirm that your current medications are on the plan's list of covered drugs (also called a formulary).
  • Understand which pharmacies in your area will accept the plan that you are considering.
  • If you travel and will need your medications while out of the area, ask about out-of-network coverage because there may be additional costs associated with filling your prescriptions.

Learn which BCBSGA plans are available in your area and compare your options. BCBSGA has online tools to help you do comparisons of the types of plans that might be best for you.

If you need more information you can also download the Medicare & You pamphlet from the Medicare.gov website.


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