Understanding Medicare Advantage and Prescription Drug Coverage

Various Medicare Advantage plans offer distinct strategies for drug coverage. Selecting the appropriate plan can help control expenses and maintain good health. This article discusses medicare advantages and prescription drug coverage in detail.

Fremont, CA: Almost 90 per cent of elderly individuals are prescribed medication. However, the cost of these medications can be high, so it is crucial to have an insurance plan that includes coverage for them. Medicare Advantage, also known as Medicare Part C, can assist.

Medicare Advantage

The United States government provides health insurance for individuals aged 65 and older through a program called Medicare, also called original Medicare. This program consists of four different categories of plans:

● Part A: Hospital insurance, which covers some of the costs of hospitalizations

● Part B: Medical insurance, which enables you to pay for regular doctor visits

● Part C: Medicare Advantage, where private insurers paid by Medicare cover your benefits

● Part D: Drug coverage, which helps pay for prescriptions.

Medicare Advantage provides an all-inclusive insurance plan that includes hospital insurance (Part A), medical insurance (Part B), and occasionally drug coverage (Part D).

When selecting a Medicare Advantage plan, various factors, such as whether prescription drugs are included, the specific medications covered, the plan's coverage regulations, the availability of local pharmacies, mail delivery options, and the anticipated out-of-pocket expenses, must be taken into account.

Do Prescription Drugs Get Covered by Medicare Advantage?

Not all Medicare Advantage plans cover prescription drugs, but most do. The ones that do cover drugs are combined with Medicare Part D and are known as Medicare Advantage Prescription Drug (MAPD) plans. MAPD plans include a variety of generic and name-brand drugs, but they do not cover all medications. You may still have to pay copays or deductibles.

If you opt for a Medicare Advantage plan that excludes prescription coverage, you may have the option to join a standalone prescription drug plan (PDP) for coverage. The eligibility for this depends on the Medicare Advantage plan you are enrolled in.

Name-Brand vs. Generic Drugs

Generic versions of products, including medications, can be found at the grocery store. Drug companies must demonstrate to the FDA that their generic drugs contain identical active ingredients, safety measures, and potency as the original brand-name medication.

Generic medications usually cost less than their brand-name counterparts. However, not all medicines have a generic alternative.

How to Find Out Whether Your Prescription is Covered?

Each MAPD plan includes a formulary that outlines the drugs, both prescription and generic, that are covered. The formulary is categorized by drug classes and categories, like antibiotics and beta-blockers, which provide information on the drugs' uses and mechanisms of action.

Medicare Advantage Prescription Drug (MAPD) plans are required to include a minimum of two medications within each category and most drugs in the protected classes, which consist of antipsychotics, antidepressants, anticonvulsants, immunosuppressants, cancer drugs, and HIV and AIDS drugs.

An insurance policy may periodically revise its list of covered medications throughout the year. This adjustment can occur due to various factors, such as the approval of new drugs, safety issues related to current medications, and new medical findings.

Modifications may occur unexpectedly. For instance, the FDA may swiftly determine a medication to be unsafe. In cases where the alteration impacts a medication you are presently using, you must be informed of the plan. The notification can be in the form of:

● A 30-day advance notice

● Written notification and a minimum 30-day stock of your medication at the existing price. This occurs during the prescription refill process.

After a month, you will need to transition to a comparable medication that is included in the formulary. If this is not feasible, you can purchase your initial medication at the total cost or request an exemption from the insurance provider.

Verifying any modifications in the formulary annually is crucial, as it is subject to change. The company's Annual Notice of Change document should also outline this detail.