Is a UnitedHealthcare Medicare Advantage Prescription Drug Plan the Same as a Standalone Medicare Prescription Drug Plan?
Last Updated : 10/21/20186 min read
If you are comparing UnitedHealthcare Medicare Advantage plans and you want Part D prescription drug coverage, you may have questions about the difference between a UnitedHealthcare Medicare Advantage plan with prescription drug coverage, also called a Medicare Advantage Prescription Drug (MAPD) plan, and a stand-alone UnitedHealthcare Medicare Part D Prescription Drug Plan. While both of these plans offer Medicare prescription drug coverage, they are two different types of plans, and it’s important to understand the differences as you’re considering the type of plan that may work for your situation.
Read on to learn how these plans work and how to get coverage for your prescription drugs.
What is a UnitedHealthcare Medicare Advantage plan with prescription drug coverage (MAPD)?
As you’re learning about your coverage options, it may help to first understand how Medicare Advantage plans work in general. UnitedHealthcare Medicare Advantage plans offer you an alternative way to get your benefits under Original Medicare (Part A and Part B). By law, they are required to provide, at a minimum, all the coverage of Original Medicare (except for hospice, which remains covered by Part A), but they may offer you additional coverage, such as prescription drug coverage, and benefits for routine vision, dental, hearing care, or wellness programs.
To be eligible for Medicare Advantage, you must have Part A and Part B, live in the service area of a plan, and you cannot have end-stage renal disease (with some exceptions). If you choose to enroll in a UnitedHealthcare Medicare Advantage Prescription Drug plan, you’ll get all of your Medicare coverage under one convenient plan: Part A, Part B, and Part D. It’s important to note, however, that not all UnitedHealthcare Medicare Advantage plans are MAPD plans; some may not offer Part D coverage for prescription drugs, so always double check with the specific plan.
Medicare Advantage plans come in many different types, including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Health Maintenance Organization Point-of-Service (HMOPOS) plans. Any of these types of plans may include prescription drug benefits and be a Medicare Advantage Prescription Drug plan.*
If you want prescription drug coverage, it’s important to choose a UnitedHealthcare Medicare Advantage plan that includes Part D benefits. In general, if you want prescription drug coverage under Medicare Advantage, you should get it through a Medicare Advantage plan that includes this coverage, not a stand-alone Medicare Prescription Drug Plan (which typically works with Original Medicare). In fact, if you are enrolled in an MAPD plan, and you later enroll in a stand-alone Medicare Part D Prescription Drug Plan, you will be automatically unenrolled from your Medicare Advantage plan and returned to Original Medicare.
Medicare plans that include prescription drug coverage use a formulary to determine benefits. A formulary is a list of covered medications and their costs. Plans may change their formularies at any time, but you will be notified in writing before they do. If you take medications on a daily basis, it’s important to check the Medicare plan’s formulary to be sure your prescriptions are covered by the plan before you enroll.
Not all UnitedHealthcare Medicare Advantage plans may be available in all locations, and plan types, benefits, and premiums may vary depending on where you live. You may have copayments, coinsurance, and/or deductible amounts with your plan. You must continue to pay your Part B premiums even after you enroll in a Medicare Advantage plan (in addition to any premium that may be required for your plan).
What is a UnitedHealthcare Medicare Part D Prescription Drug Plan?
Medicare Prescription Drug Plans provide stand-alone coverage for beneficiaries enrolled in Original Medicare. Under the federal program, you’re covered for prescription drugs that you receive as part of covered inpatient hospital and skilled nursing facility stays under Part A. You’re also covered for certain outpatient medications under Part B; typically, these are the kind you can’t give yourself, such as infusion drugs. But if you want help with Medicare prescription drug costs beyond this, you’ll need to enroll in a Medicare Prescription Drug Plan.
You may be eligible for a UnitedHealthcare Prescription Drug Plan if you have Part A and/or Part B and live in the service area of a plan. You’ll need to stay enrolled in Original Medicare for your hospital and medical coverage.
These plans come with a separate premium for your coverage, and plan benefits, copayments, deductibles, coinsurance amounts, and premiums may vary depending on the plan you choose and where you live. You’ll need to keep paying your Part B premium, in addition to any premium required for your Medicare Prescription Drug Plan.
Whether you choose to enroll in a UnitedHealthcare Medicare Advantage Prescription Drug plan or a stand-alone Medicare Prescription Drug Plan, you should sign up for Part D as soon as you are eligible. If you wait, you may have to pay a late-enrollment penalty with your monthly premium for as long as you have Medicare prescription drug coverage. You may owe a late-enrollment penalty if you wait to sign up for Part D after you’re first eligible and don’t have other creditable prescription drug coverage (insurance that is as good as the Medicare prescription drug benefit) for 63 days in a row or more.
Keep in mind that your medication costs may vary greatly from plan to plan, so it’s important to compare all the available plan options in your area, regardless of whether you’d like to get your Part D benefits through a Medicare Advantage plan or a stand-alone plan.
- If you’d like to learn more, you can visit the UnitedHealthcare Medicare profile page to learn about prescription drug coverage and the choices available to you.
- You can start browsing plan options in your location right now by clicking the Find Plans button. If you like, you can enter your current prescription drugs to filter your search to plan options that cover your medications.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.