Does Medicare Advantage Cover Prescription Drugs?

Medicare Advantage plans are geared to cover gaps left by Original Medicare. While these plans combine coverage available by Original Medicare, they also include coverage for different health care needs you may face as you grow older.

At their most basic policies, neither Original Medicare nor Medicare Advantage cover prescription drugs. However, you can add coverage for prescription drugs to your Medicare Advantage policy. Prescription drug coverage is called Plan D.

Plan D Medicare specifically covers drugs prescribed by your healthcare provider. Some policies even cover delivery for prescription drugs, which can conveniently cut out the need to go to the pharmacy every time you need a refill. Be sure to speak with your insurance agent about the options available to you. Some medications may not be fully covered or have limits coverage under your insurance.

What Prescription Drugs are Covered Under Medicare Plan D?
Medicare on Chalk board

There are different categories, also called tiers, which split up certain prescription drugs under this plan. In general, Plan D must cover at least two medications in each category. These are generally name-brand drugs. If you take an off brand of a covered prescription, however, you may still, be covered under Medicare Plan D. If it isn’t, a similar drug that is covered should be offered.

The main tiers of Medicare Plan D are:

Tier 1: Tier 1 has the lowest copayment and generic prescription drugs.
Tier 2: Tier 2 has a medium copayment and preferred, brand name prescription drugs.

Tier 3: Tier 3 had a higher copayment and non-preferred but still brand name prescription drugs.
Specialty Tier: A specialty tier includes those with the highest copayment and most expensive prescription drugs.

Be sure to speak with whoever prescribes you medication to understand what tier your prescription drugs fall into, as well as if there are ways to save money by switching tiers.

Generic drugs may be cheaper than brand name drugs, but there aren’t always generic drugs available depending on your health needs. In order to be a true generic drug, they typically must copy brand-name drugs in:

Safety

Strength
Type of administration
Quality
Performance
Intended use

Dosage

The more expensive your prescription drugs, the more you may pay out of pocket. Also keep in mind that, while this insurance does provide a significant amount of coverage, it cannot cover everything. Certain drugs may be excluded, so speak with your insurance agent if you have any questions.

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Does Medicare Advantage Cover Prescription Drugs?

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With a wide variety of Medicare plans to choose from it can be difficult to know if you are getting the best coverage for the lowest cost based on your needs. Fortunately, help is just a phone call away!