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Advantage and Part D

The Medicare web site says a person cannot legally have a Medicare Advantage plan that includes drug coverage at the same time as having a Part D plan. It also says that if you have an Advantage HMO plan with drug coverage, you can reject that coverage and buy a separate drug plan, but if the HMO does not have drug coverage, you cannot get a separate drug plan. For all three issues, would someone please explain in detail why that is? Thanks.

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Honored Social Butterfly

Suggest you talk to a local expert on this subject. I have had D drug coverage under typical Medicare and under Medicare Advantage. Never had a gap in coverage, and amount I pay is less than normal. There are ways of using part D and having better coverage with an outside source paying some of the claim costs. In my case that made Medicare equal to the employee drug program.

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Honored Social Butterfly

I had to go back on everything I just said to you - Here is the way it goes:

From Medicare and You 2023 - page 64 (quote)

Medicare drug coverage (Part D)
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In
certain types of plans that don’t include Medicare drug coverage (like Medical
Savings Account Plans and some Private-Fee-for-Service Plans), you can join
a separate Medicare drug plan. However, if you join a Health Maintenance
Organization or Preferred Provider Organization Plan which doesn’t cover drugs,
you can’t join a separate Medicare drug plan.


In this case, you’ll either need to use other prescription drug coverage you have
(like employer or retiree coverage), or go without drug coverage. If you decide
not to get Medicare drug coverage when you’re first eligible and your other
drug coverage isn’t creditable prescription drug coverage, you may have to pay
a late enrollment penalty if you join a plan later.

 

So the actual Medicare.gov website is very confusing because MA - HMO & PPO types are different and thus you need to find these type of plans WITH an included prescription drug plan in order to get one.

 

OK now?

It's Always Something . . . . Roseanna Roseannadanna
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Contributor

Thanks so much for all the research and effort you put into this. However, my question was: Why can't a person buy a separate Part D plan if he or she has an Advantage HMO (or PPO) plan that does not have drug coverage? 

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Honored Social Butterfly


@dedlnr wrote:

. . .. . my question was: Why can't a person buy a separate Part D plan if he or she has an Advantage HMO (or PPO) plan that does not have drug coverage? 


Because Medicare Advantage plans of the HMO or PPO type are supposed to have them built into the plan itself - all inclusive - medical and drug benefit.  

I will assume the reason is to manage your health care and drug needs more efficiently.  

 

EDITED to add:  Medicare Advantage Only (MAO) plans that have NO prescription drug plan included within it are only for those who may have credible prescription drug coverage from another source like the VA.

 

 

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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