Is Medicare Part D Part of Medicare Advantage?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 11/23/2018

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If you’ve been introduced to Medicare, you know that Medicare likes to separate out parts of your health care coverage and name these parts according to letters from the alphabet. Medicare Part A is hospital insurance. Medicare Part B is medical insurance. Medicare Part D is prescription drug coverage. Medicare Part C (also called Medicare Advantage) is a way to get your Medicare Part A, Part B, and Part D benefits all in one plan. Medicare Part D prescription drug coverage is usually included in Medicare Advantage plans. According to the Kaiser family foundation, 88% of Medicare Advantage plans offered prescription drug coverage in 2017.

What is Medicare Advantage?

Medicare Advantage is Medicare coverage offered by private insurance companies that contract with Medicare. Medicare Advantage plans are required to cover everything that Original Medicare (Part A and Part B) cover. As well as prescription drug coverage, Medicare Advantage plans often offer additional extra benefits, such as routine dental care, routine vision care, and routine hearing care.

What is Medicare Part D?

Medicare Part D is prescription drug coverage. You can get Medicare Part D either through a stand-alone plan or through a Medicare Advantage plan. If your Medicare Advantage plan includes prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D Prescription Drug Plan at the same time. Stand-alone Part D prescription drug plans generally go together with Original Medicare coverage.

All Medicare Part D coverage is offered by private insurance companies and not by the federal government. The government’s Medicare program, Original Medicare, does not include coverage for most prescription drugs you take at home. You will generally only get Original Medicare coverage for prescription drugs if you receive them as a hospital inpatient or as injection as a doctor office outpatient. There may only be other limited situations where Original Medicare will pay for prescription drugs. Without Medicare Part D coverage, you may have to pay for most of your prescription drugs out of pocket.

How does a Medicare Advantage plan with Medicare Part D included cover my prescription drugs?

The prescription drugs covered by your Medicare Advantage plan will be listed in the plan’s formulary, or list of covered medications. If a prescription drug you need is not covered by your Medicare Advantage plan’s formulary you can appeal that it be covered or switch plans during the Open Enrollment Period October 15-December 7 each year. Medicare Advantage plans generally put covered prescription drugs on tiers, which is a way to charge for different prescriptions. Tier 2 prescription drugs typically cost more than tier 1 prescriptions, and so forth.

For example, for a 30-day supply of your medication you may pay:

Tier 1 (Preferred Generic) $10.00 copay

Tier 2 (Generic): $17.50 copay

Tier 3 (Preferred Brand): $45.00 copay

Tier 4 (Non-Preferred Drug): $95.00 copay

Tier 5 (Specialty Tier) 33% coinsurance

Tier 6 (Select Care Drugs)  $10.00 copay

Do you want to find a Medicare Advantage plan in your area that includes Medicare Part D coverage for prescription drugs? Just enter your zip code on this page to begin searching.

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