Medicare Plans; Selecting Prescription Drug Coverage
Understanding Medicare can be complex. Prescription drug coverage is especially important because Original Medicare and Medicare Advantage handle medications differently.
Original Medicare And Prescription Drugs
Original Medicare offers limited prescription drug coverage, and many beneficiaries enroll in a separate Part D plan.
Medicare Part A
Part A covers drugs provided during an inpatient hospital or skilled nursing facility stay.
Medicare Part B
Part B covers a limited number of outpatient drugs under specific circumstances, including certain injectable drugs, chemotherapy drugs, and vaccines.
Medicare Advantage And Prescription Drugs
Many Medicare Advantage plans include prescription drug coverage and are called MA-PD plans.
Working Of MA-PD Plans
Formularies
Each MA-PD plan follows a formulary, or list of covered generic and brand-name drugs, organized into cost tiers.
Cost-Sharing
Out-of-pocket costs vary based on the plan and the drug tier.
Network Pharmacies
Most plans use pharmacy networks and may offer lower costs at preferred pharmacies.
What Would be the Right Decision?
The best approach depends on your health requirements, medications, preferred pharmacies, and financial situation.
They bundle medical and prescription drug coverage into one plan and use a formulary with tiered copayments or coinsurance.