One of the top benefits of most Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). is they bundle in prescription drug coverage. We get a lot of questions from readers wanting to know if they can get prescription drug coverage bundled with Medicare supplement insurance (aka, Medigap).
The short answer is no.
You can get prescription drug coverage through Medicare in one of two ways. The most common way is to buy a Medicare Part D Plan (aka, “PDP”). The second way is to enroll in a Medicare Advantage Plan that includes Part D (aka, “MAPD”). All PDPs sold today are 100% compatible with all Medigap supplemental Medicare policies. This is not true in the case of Medicare Advantage plans. You cannot purchase Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. if you are enrolled in Medicare Advantage.
What Are My Options If I Don’t Have Prescription Drug Coverage?
If you have Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. (also known as Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.) and a Medigap plan you have two options:
- Keep your Medicare supplement insurance and purchase the Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan of your choice. Be certain that the PDP you want covers your prescribed medications at a favorable rate; or
- Cancel your Medigap plan and get your coverage through a Medicare Advantage plan that includes Part D (an MA-PDA Medicare Advantage plan that offers Medicare prescription drug coverage (Part D), Part A, and Part B benefits in one plan. plan). When you enroll in a MA-PD plan you will be automatically disenrolled from Original Medicare (Part A and Part B).
Related: Medicare Advantage vs. Medigap
Timing is critical. Unlike your Medigap policy, you can only enroll in Medicare Part D and Medicare Advantage during the Annual Enrollment PeriodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. (AEP), which begins 15 October and ends on 7 December (Obamacare does not change Medicare’s AEP dates). Even though you join during the open enrollment periodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31., your coverage does not begin until 1 January. The only exceptionIn a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the... to this rule is when you turn 65. In that year you have an Individual Enrollment Period starting the month before your birthday and ending the month after your birthday.
What If I Have A Medigap Plan With Prescription Drug Coverage?
Some Medicare supplements sold prior to 2006 (Plans H, I, J) have limited prescription drug coverage. These insurance policies are no longer available. If you have a Plan H, I, or J policy with prescription drug coverage, there are two options available to you:
- You can change your Medigap policy to one of the 10 lettered plans currently available and purchase a PDP plan. Before doing so, first, compare the drug coverage your Medigap policy offers with the coverage provided by Medicare Part D plans sold in your state. Don’t forget, the new healthcare law will eliminate the coverage gapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. in a few more years.
- Cancel your Medigap policy and enroll in an MA-PD. This will give you all of your Medicare coverage, Parts A, B, and D, through an HMO or PPO private healthcare plan. When you enroll in Medicare Advantage, you will be disenrolled from Original Medicare.