Can I enroll in a Medicare Advantage plan and then add prescription drug coverage through a stand-alone Medicare Part D plan?
Only in limited circumstances.
Usually a person cannot be enrolled in a Medicare Advantage plan that does not include drug coverage and then add a separate stand-alone Medicare Part D drug plan (PDP) -- with only a few exceptions:
you can join a Medicare Advantage PFFS
plan that does not have drug coverage or
(2) a Medicare Medical Savings Account (MSA
) and add a stand-alone Medicare Part D prescription drug plan (PDP
(3) you can add additional Medicare Part D prescription drug coverage if you are enrolled in a Medicare Cost plan
(in fact, as noted by the 2023 Medicare & You
Handbook: "You can join a separate Medicare drug plan or you can get Medicare drug coverage (Part D) from the Cost Plan (if offered). You can choose to get a separate Medicare drug plan even if the Cost Plan offers Medicare drug coverage").
As a reminder: Medicare Advantage plans are available in two general varieties:
Advantage plans with prescription drug coverage (MAPDs) and
Advantage plans without prescription drug coverage (MAs).
And again, if you enroll in an “MA” plan (a Medicare Advantage plan with no drug coverage), you are not
allowed to add a
separate Medicare Part D plan unless the MA plan
is a Private Fee-for-Service (PFFS)
Medicare Advantage plan without
drug coverage or a Medicare Medical Savings Account (MSA) plan
or a Medicare Cost plan
But, you cannot add Part D drug coverage to an HMO or PPO MA plan.
So, if you are enrolled in a Medicare Advantage HMO
or Medicare Advantage PPO
plan that does not include
drug coverage and you enroll
into a stand-alone Medicare Part D plan (PDP), you probably will be automatically disenrolled from your Medicare Advantage plan and returned
you to original Medicare Part A and Medicare Part B - but you will still have your newly-selected stand-alone Medicare Part D drug plan.
If you want a Medicare Advantage HMO or PPO plan with drug coverage - join a MAPD, not a MA plan.
Likewise, if you have a stand-alone Medicare Part D plan
(PDP) and try to join a Medicare Advantage HMO or PPO plan (with or without drug coverage), you will lose your stand-alone Medicare Part D
coverage automatically - and have the Medicare Advantage plan instead.
A few more details . . .
Question: Who would want a Medicare Advantage plan without drug coverage (MA)?
Since you cannot join an HMO or PPO Medicare Advantage plan that does not provide
prescription coverage and also enroll in a stand-alone Medicare
Part D plan, why
would anyone enroll in an HMO or PPO MA?
A Medicare Advantage HMO or PPO without drug coverage
may be an option for some people who already receive
their prescription drug coverage from another source other than a
stand-alone Medicare Part D plan (such as having VA drug coverage).
Question: Where can I find this information in an official Medicare document?
The annual Medicare & You Handbook describes each type of Medicare
Advantage plan and whether you are allowed to add a separate Medicare
Part D plan to the Medicare Advantage plan (please note that the
language in the Medicare & You Handbook can change year-to-year).
You can look under the section in the Handbook about different Medicare
Advantage plans and find text such as:
Are prescription drugs covered?
- HMO plans - the handbook states: "In most cases, yes. If you want Medicare drug coverage, you must join an HMO plan that offers prescription drug coverage."
- PPO plans - "In most cases, yes. If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage."
- PFFS plans - Here the handbook states: "Sometimes.
If your PFFS plan doesn't offer drug coverage, you can join a
stand-alone Medicare Prescription Drug plan (PDP) to get coverage."
- SNP - "Yes. All SNPs must provide Medicare prescription drug coverage (Part D).
And a bit of Medicare Handbook history...
In the first year the Medicare Part D program (2005-2006),
we heard from a number of Medicare advocates wondering why people
Advantage HMOs immediately lost their Medicare Part D prescription
drug coverage - and explanation was because most people were not well
informed about what happened to their Medicare Advantage plan when they
tried to add Part D drug coverage (or for some people, trying to add
additional Part D coverage to their Medicare Advantage plan that already
The 2006 Medicare and You Handbook
only referenced adding Medicare Part D coverage to a Medicare Advantage
plan - but not the consequences for people enrolled in a Medicare
Advantage HMO or PPO:
"If you join a Medicare Advantage Plan or Other Medicare
Health Plan . . . you may be able to get prescription drug coverage
through the plan. If you are in most Medicare Advantage Plans and other
Medicare Health Plans, you must get your Medicare prescription drug
coverage from the plan if it’s offered. If you have a Medicare Private
Fee-for-Service Plan that doesn’t offer Medicare prescription drug
coverage, or if you have a Medicare Cost Plan, you can join a Medicare
Prescription Drug Plan." (p.31)
Then in the 2007 Medicare & You Handbook
, Medicare directly addressed the issue providing clear information about what happens when a
person tries to join both a Medicare Advantage HMO or PPO and a
stand-alone Medicare Part D prescription drug plan (p.40):
"If you belong to a Medicare Advantage HMO or PPO, you can only get
Medicare prescription drug coverage from your plan (if offered). If you
join a stand-alone Medicare Prescription Drug Plan, you will be
automatically disenrolled from your Medicare HMO or PPO and returned to
the Original Medicare Plan."
Unfortunately, over the years, the Medicare & You Handbook
was continually "updated" and began providing rather vague advice on
the subject of adding drug coverage to a Medicare Advantage plan.
43, the 2010 Handbook
notes that for Medicare Advantage plans you
need to “Decide If You Want Prescription Drug
Coverage (Part D)” - the Handbook then continues to note that "[i]f you want prescription drug coverage, and
it’s offered by your plan, in most cases you must get it through your
plan. If your plan doesn’t offer drug coverage, you can choose and join a
Medicare Prescription Drug Plan. See pages 55–57.
Then, on page 55 of the 2010 Medicare & You Handbook, the subject of HMO and PPO Medicare Advantage plans
are addressed and the handbook notes more directly that:
“If you want drug coverage, you must join an HMO Plan that offers prescription drug coverage.”
So with the clarification provided later in the Handbook, we can only assume that the earlier page 43 of the
2010 Medicare & You handbook is referring to Medicare Advantage
plans in the form of Private Fee for Service plans (PFFS) - that may
allow beneficiaries to join a separate stand-alone Medicare Part D plan along with
their PFFS Medicare Advantage plan that does not include drugs.
As reference, you can download and review any Medicare & You Handbooks from 2006 through present.
If you wish to join a Medicare Advantage plan HMO or PPO, then you
should look for an HMO PPO that is also a MAPD plan covering prescription drugs.
How can I see the Medicare Advantage plans with and without drug coverage in my area?
If you wish to find the Medicare Advantage plans in your area, you can use our MA-Finder: MA-Finder.com
to see if a Medicare Advantage plan includes prescription drug coverage.
Click here for an example of Medicare Advantage plans available in Allegheny County, Pennsylvania.
You can also browse for a Medicare Advantage plan by the counties in
your state. Here is an example of the Medicare Advantage plans for
Florida counties: MA-Finder.com/FL
or Texas using MA-Finder.com/TX