When it comes to managing a chronic condition or fighting off a nasty virus, medications are vital to our health — and in some cases, can even be lifesaving. But they can also be more costly if you don't have prescription drug coverage. That's why it's important to sign up for a Medicare plan that will help cover the costs of your prescription medications. This coverage is called Medicare Part D.
With Medicare, there are two ways to get prescription drug coverage: You can either enroll in a Medicare prescription drug plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage (MAPD). Which is right for you? It all depends on what you're looking for in a prescription drug plan. To help you decide, we're sharing some important information about both options.
Understanding Medicare prescription drug plans (PDPs)
A PDP adds prescription drug coverage to Original Medicare (Parts A and B). Medicare Advantage plans may also include prescription drug coverage, but for those that don't (such as Medicare Advantage-only plans, Medicare Medical Savings Account (MSA) plans, Medicare Private Fee-for-Service (PFFS) plans, and Medicare Cost plans), a PDP can also be added to these plans. If you choose to enroll in a PDP, you must join a plan approved by Medicare.
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Understanding prescription drug coverage under a Medicare Advantage plan (MAPD)
Unlike Original Medicare (which is offered directly through the federal government), Medicare Advantage plans are offered through private companies that contract with the federal government. Medicare Advantage plans include Part A (hospital insurance) and Part B (medical insurance), but may offer even more coverage — like Part D (prescription drug) coverage.
The types of prescription drug coverage offered by a Medicare Advantage plan will vary across plans. This is because Medicare Advantage plans may have different restrictions, costs, and coverage rules. A Medicare Advantage HMO plan, for example, may require you to go to an in-network pharmacy for prescription drug coverage. A Medicare Advantage PPO plan, however, may allow you to go to a pharmacy outside of your plan's network, it may just cost you more. Some Medicare Advantage plans won't offer prescription drug coverage, so it's always best to check with a plan directly to find out how its coverage works.
Keep in mind — you can't be enrolled in a PDP and an MAPD plan at the same time. If you choose to get your prescription drug coverage through a PDP rather than through your MAPD plan, your MAPD plan will disenroll you and you'll go back to Original Medicare.
Understanding Part D coverage
When it comes to getting your prescription medications covered by a PDP or MAPD plan, it's important to consider your plan's rules and restrictions, as well as its formulary. A formulary is a list of drugs your plan will cover. Many Medicare prescription drug plans put drugs into different "tiers" on their formularies. A drug in a higher tier may cost you more than a drug in a lower tier. If you're taking a "high-tier" drug, talk to your doctor to see if you can switch to a generic version or cheaper alternative. If a cheaper alternative isn't available, your doctor may also be able to ask your plan for an exception to get a lower copayment for a high-tier drug.
Remember, it's important to check the formularies of the prescription drug plans you're interested in before joining them to make sure they help cover the medications you're taking.
Choosing the right Part D coverage can make a big difference in your well-being, so make sure you do your research before choosing a prescription drug plan. Your health and wallet will thank you.
Rachel Quetti is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Rachel isn't trying out new fitness classes, she is cooking up fun, (mostly) healthy recipes in the kitchen. Rachel lives in Watertown, Massachusetts and has a degree in journalism from the University of Massachusetts, Amherst.
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