Part D/RX Plan

Part D Prescription Drug Plans (PDP's)

PDP plans are stand-alone drug plans that add prescription coverage to Original Medicare, to Medicare Supplements, and to some others, such as Medicare Cost Plans, some Medicare Private-Fee-For-Service Plans, and Medicare Medical Savings Account Plans. These PDP plans are sold by private insurance companies and other private companies approved by Medicare. There is a monthly premium for these plans that vary depending on company and plan. Some will have deductibles as well as copays/coinsurance, others will not. All must offer a minimum of 2 drugs in every category.

Medicare offers Prescription Drug coverage to everyone with Medicare, whether on Part A, Part B or both. It is not required to get a PDP but there will likely be a penalty of 1% per month added if bought later during an Annual Enrollment Period or Special Election Period, unless the recipient gets Extra Help or has had other creditable prescription drug coverage. There is an initial enrollment period when first enrolled in Medicare, and once a year from October 15 through December 7, is the Annual Enrollment Period when a Medicare recipient can add or change their drug coverage. There are also Special Election Periods for those that qualify under special circumstances to be able to change or add prescription coverage.

Medicare Advantage Plans (Part C – MA's and MAPD's)

Medicare Advantage Plans are a type of Medicare health plan, also offered by private insurance companies that contract with Medicare to provide all you Medicare Part A and Part B benefits, all Medicare Services. You must have both Medicare Part A and Part B to be able to buy an Advantage plan.

This type of plan pays instead of Medicare. It can include Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPO's), Private Fee-For-Service (PFFS), Special Needs Plans (SNP’s) and Medicare Medical Savings Account (MSA’s) Plans. If contracted with an Advantage plan, you still have Medicare, and still have to pay the Medicare Part B premium, as well as the premium for the Advantage plan.

Many, but not all, of these plans, also include Prescription Drug coverage, and those that do offer it must follow the same rules as Medicare Prescription Drug Plans (PDP’s). These rules can change from year to year and the plan must notify their members about any and all changes before the start of the next enrollment year. Medicare Advantage plans may also offer extra coverage, such as vision, dental, chiropractic, hearing and/or health and wellness programs.

A Medicare recipient cannot have both an Advantage plan and a Medicare Supplement. If enrolled in a Medicare Advantage plan, the Medicare services are covered through that plan and are not paid by Original Medicare. This type of plan is guaranteed with no health questions asked and no underwriting required. Many refer to this type of plan as an "All-In-One" plan.

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