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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 two exceptions -- you can join a Medicare Advantage PFFS plan that does not have drug coverage or a Medicare Medical Savings Account (MSA) and add a stand-alone Medicare Part D prescription drug plan (PDP).

As a reminder: 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).
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.

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.

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?

Short answer:
  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 joining Medicare 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 covered drugs).

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.

On page 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.

Bottom Line...

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, etc.





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Tips & Disclaimers
  • 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 PDP-Compare.com and MA-Compare.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.
  • 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.