Medicare Advantage plans are available in two general varieties: Medicare
Advantage plans with prescription drug coverage (MAPDs) and Medicare
Advantage plans without prescription drug coverage (MAs).
If you enroll in an “MA” plan (a Medicare Advantage plan with no drug coverage), you are not able 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 Medical Savings Account (MSA) plan
If you are enrolled in a Medicare Advantage HMO
or Medicare Advantage PPO
in stand-alone Medicare Part D plan will automatically disenroll you from your Medicare Advantage plan and return
you to original Medicare Part A and Medicare Part B.
Likewise, if you have a stand-alone Medicare Part D plan
(PDP) and try to join a Medicare Advantage HMO or PPO plan, you will lose your Medicare Part D
A few more details...
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?
The HMO or PPO MA may be an option for Medicare beneficiaries who already receive
their prescription drug coverage from another source other than a stand-alone Medicare Part D plan.
The Medicare & You Handbook describes each type of Medicare Advantage plan and each has a section
Are prescription drugs covered?
- HMO plans - 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 - "In most cases, yes. If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage."
- PFFS plans - are a different story. "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).
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
And a bit of Medicare history...
The 2010 Medicare & You Handbook is a little confusing. On page
43 it 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."
However, 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.
We conclude 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.
Download Medicare & You Handbooks from 2006 through present.
As a note, in the early days of the Medicare Part D program (2005-2006), we heard from a number of Medicare advocates wondering why people joining Medicare
Advantage HMOs immediately lost their Medicare Part D prescription
If you wish to join a Medicare Advantage plan HMO or PPO, then you
should look for an HMO PPO MAPD plan that also covers prescription drugs.