MA-PD stands for Medicare Advantage Prescription Drug Plans. These plans serve as an alternative to Original Medicare benefits while providing prescription drug coverage. Medicare Part A and Part B cover various hospital and medical expenses but do not offer coverage for prescription drugs. Medicare Advantage Prescription Drug Plans offer the same medical and hospital benefits provided by Medicare Part A and Part B, in addition to prescription drug coverage.
Some Medicare Advantage Drug Plans also offer some extra benefits Medicare Part A and Part B do not provide, such as routine hearing coverage, vision coverage, and dental coverage. Medicare Advantage Prescription Drug plans vary by cost and the medications covered as they are sold by private insurance companies. The type of Medicare Advantage plan that you enrolled in will affect how the prescription drug plan will work.
PPOs and HMOs
If you enroll in a Preferred Provider Organization plan, you will pay a lesser amount if you stay within the network of the healthcare providers or pharmacies that are associated with the PPO plan. Your out-of-pocket costs will increase if you visit a pharmacist or provider that is not part of the PPO network.
If you enroll in a Health Maintenance Organization plan, it is mandatory to stay within the plan’s network. If you move outside the network, you will have to cover all the costs from your own pocket.
PFFS and SNPs
Private Fee For Service plans allow you to visit any pharmacist or provider as long as they accept Medicare.
Special Needs Plans always offer prescription drug benefits and provide tailored prescription drugs to their members.
Formularies and Coverage Gaps
Medicare Advantage Prescription Drug plans all have their own formulary. The formulary contains the generic and brand name prescriptions that the plan covers. The drugs are then categorized into different tiers. The lower tier drugs cost less than the high tier drugs.
Some Medicare Advantage Prescription Drug plans have a coverage gap or donut hole. This refers to the temporary coverage limit on prescription drug costs. The coverage gap varies depending on the year.