A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search

Can I enroll in an HMO and then add prescription drug coverage through a stand-alone Medicare Part D plan?

Category: Medicare Advantage Plans MAPD
Published: Dec, 13 2014 08:12:25


Short Answer:

No. Most Medicare Advantage plans include integrated Medicare Part D prescription drug coverage (and are called MAPDs).  This drug coverage must comply with all of the same requirements as a stand-alone Medicare prescription drug plan.  However, some Medicare Advantage plans offer “medical services” only and DO NOT include the Part D prescription drug coverage (and are called MAs).

If you enroll in an “MA Only” plan, you are prohibited from purchasing a separate Part D plan unless the MA-Only plan is a Private fee-for-service or PFFS plan without drug coverage or an MSA plan. If you are enrolled in an Medicare Advantage HMO, enrolling in a Medicare Part D plan will automatically disenroll you from your HMO.

A few more details:

As noted, you cannot join an HMO Medicare Advantage plan that does not provide prescription coverage (MA HMO) and also enroll in a stand-alone Medicare Part D plan.  The MA HMO may work for people who are already receiving their prescription drug coverage from another source (such as VA drug coverage) - but they cannot be enrolled in a stand-alone Part D plan.  If you have a stand-alone Part D plan and try to join one of these MA HMO plans, you will lose your Part D coverage automatically.

The 2016 Medicare & You Handbook describes each type of Medicare Advantage plan and each has a section Are prescription drugs covered?  
  • HMO plans - on page 90 it states "In most cases, yes.  If you want Medicare drug coverage, you must join an HMO plan that offers prescription drug coverage."
  • PPO plans - on page 91 "In most cases, yes. If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage.
  • PFFS plans - on page 92 - are a different story.  "Sometimes.  If you PFFS plan doesn't  offer drug coverage, you can join a Medicare Prescription Drug plan (Part D) to get coverage."  
  • SNP - on page 93, "Yes. All SNPs must provide Medicare prescription drug coverage (Part D).

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, etc.

A bit of history:
The 2010 Medicare & You Handbook is a little confusing and on page 43 notes that for Medicare Advantage plans “like an HMO or PPO” you need, as the second step to “Decide If You Want Prescription Drug Coverage (Part D)” and "[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." 

This statement is a little unclear.

However, on page 55, 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.

The only thing that we can conclude is 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 you to join a separate stand-alone Medicare Part D plan along with the Medicare Advantage plan.

Here is a quote from an earlier Medicare & You Handbook that provides the information more clearly: 

"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."

As a note, in the early days of the Medicare Part D program, we had a few advocates that contacted us about how people joined these Medicare Advantage HMOs and immediately lost their Medicare Part D prescription drug coverage.

In short - if you wish to join a Medicare Advantage plan HMO, then you should look for a plan that also covers prescription drugs.

(Thanks to Gail S. for this question)






Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs




Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.




Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.