Is an Anthem Medicare Advantage Prescription Drug Plan the Same as a Standalone Medicare Prescription Drug Plan?
This article was updated on: 10/21/2018
If you are new to Medicare, you may not know that there are four components to the Medicare program:
- Part A (hospital insurance)
- Part B (medical insurance)
- Part C (Medicare Advantage)
- Part D (prescription drug coverage)
Original Medicare is made up of Part A and Part B and is administered by the federal government. Private insurance companies like Anthem may contract with Medicare to provide Medicare Advantage and Medicare Part D Prescription Drug Plans. As a Medicare beneficiary, you can get help with Medicare prescription drug costs either through a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
As you consider your own prescription drug needs and the type of coverage that may work best for your situation, it may help to first understand the difference between Anthem Medicare Advantage Prescription Drug plans and Anthem stand-alone Medicare Part D Prescription Drug Plans. Here’s an overview of how both types of plans work.
What are Anthem Medicare Advantage Prescription Drug plans?
By law, all Anthem Medicare Advantage plans must, at minimum, provide the same coverage as Original Medicare (except for hospice care, which is still covered under Part A), but some may offer additional benefits, such as coverage for prescription drugs, routine vision and dental care, and/or the SilverSneakers wellness program.
If your Anthem Medicare Advantage plan includes prescription drug benefits, as many do, you do not need to enroll in a stand-alone Medicare Prescription Drug Plan (which typically provides prescription drug coverage if you have Original Medicare).
Your prescription drug coverage is outlined in a formulary, or list of covered drugs. Plans may change their formularies at any time, but they must notify you in writing before any changes occur.
All Anthem Medicare Advantage Prescription Drug plans and Anthem Medicare Part D Prescription Drug Plans must provide at least the standard minimum formulary coverage required by the Medicare program. For example, each plan that offers Medicare prescription drug coverage is required to cover almost all medications in certain protected drug classes.
Other things to keep in mind about Anthem Medicare Advantage plans:
- Not all plans are available in every location, and plan benefits and premiums may vary depending on where you live.
- You must continue to pay your Part B premium if you enroll in an Anthem Medicare Advantage plan; you may also have an additional monthly premium from Anthem for your Medicare Advantage coverage.
- Your coinsurance, copayment, and applicable deductibles may be different depending on the medications your doctor prescribes and your plan’s specific formulary.
- Depending on the plan you choose, you may be required to get your prescription drugs from an Anthem Medicare network provider to access benefits, or you may pay more out-of-pocket costs for medications purchased out-of-network.
- Not every Anthem Medicare Advantage plan includes prescription drug coverage (although most do). Always check with the specific plan before enrolling.
What is an Anthem stand-alone Medicare Part D Prescription Drug Plan?
Stand-alone Medicare Part D Prescription Drug Plans are meant to supplement your coverage under Original Medicare. Prescription drug coverage is limited under Original Medicare, and you’ll need to enroll in Part D for coverage of most medications. Like Medicare Advantage Prescription Drug plans, these plans also use a formulary and must provide the minimum benefits required by the Medicare program. You may have copayments or coinsurance amounts that differ based on the medications you take and your plan formulary.
Things to keep in mind about Anthem Medicare Part D Prescription Drug Plans:
- These plans generally may not be combined with a Medicare Advantage plan with prescription drug coverage; if you enroll in a stand-alone Medicare Part D Prescription Drug Plan while enrolled in a Medicare Advantage that includes prescription drug coverage, you will be automatically removed from Medicare Advantage and enrolled in Original Medicare. The exception is if your Medicare Advantage plan doesn’t offer Part D coverage; in this case, you may be allowed to get your prescription drug benefits through a stand-alone Medicare Prescription Drug Plan.
- Not all plans are available in every location, and plan premiums and benefits may vary by city or state.
- You pay a separate premium for these plans. It’s important to enroll in Medicare prescription drug coverage as soon as you are eligible, or you may have to pay a late-enrollment penalty each month for as long as you are covered. The late-enrollment penalty may apply any time you go without Part D and don’t have other creditable prescription drug coverage (insurance that pays, on average, as much as the standard Part D benefit) for 63 days in a row or more.
Medicare Part D costs can vary widely from plan to plan. Most Medicare plans place covered medications into “tiers,” and depending on the cost tier that your prescription drugs fall under, your copayments or coinsurance costs could be more or less. You may find that one Medicare plan has higher copayments or deductibles than another, even when covering the exact same prescription drugs. Because of this, it can be helpful to compare plan options to find prescription drug coverage that fits your budget.
Ready to browse plan options right now? You can do that by clicking on the Find Plans button on this page; enter your current medications into the tool to view plan options that cover your prescription drugs.
Anthem Blue Cross and Blue Shield serves Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.