You can get your Part D benefits two ways. You can enroll in a Medicare Advantage plan with Part D included or you can choose a stand-alone Part D plan.
The allure of an Advantage plan includes having a low or $0 monthly premium along with manageable copayment amounts as well as extra benefits not normally included in original Medicare.
Medicare Advantage plans with Part D included like AARP MedicareComplete are a popular choice but you need to be careful.
If you are considering a stand-alone plan, all your focus is on whether or not that plan is your best choice. When you consider a Medicare Advantage plan you may have the tendency to put more emphasis on the medical benefits and not delve into the Part D portion of the plan like you should.
Following is a discussion of considerations to take into account when making a determination whether or not MedicareComplete includes sufficient Part D coverage.
Compare Medicare Plans Without Submitting Your Info Online – Call (888) 310-0376
AARP MedicareComplete Part D formulary is key
Generally, when you shop for a Part D plan, you weigh the different features against your needs.
You can assign your own level of importance to such things as, premiums, deductibles, whether or not there is extra coverage in the gap and how the plan is rated by Medicare.
Whether you choose a plan with a basic formulary or an enhanced formulary will depend on the prescription drugs you are required to take.
A basic formulary will include the most popular drugs prescribed to people on Medicare. Don’t expect to find many specialty or less common drugs to be included in a basic formulary.
The reason that premiums for Part D plans with enhanced formularies are often two or more times higher than plans with basic formularies is primarily due to the drugs that are covered.
When you enroll in a Medicare Advantage plan with Part D included you must by default accept the plan’s formulary. You cannot separate the medical benefits from the drug benefits.
Also, if you choose an Advantage plan with medical-only benefits you may or may not be able to add a stand-alone Part D plan.
HMO and HMO-POS plans typically include Part D. Some PPO plans provide only medical benefits without Part D included. But you are not allowed to add Part D to a medical-only PPO plan.
You are allowed to enroll in a Private Fee-For-Service (PFFS) Medicare Advantage plan with medical-only benefits and add a stand-alone Part D plan.
But MedicareComplete is not offered as a PFFS plan and includes Part D by design. If you are going to enroll in MedicareComplete you must accept the drug coverage as is.
Assessing your needs
Deciding whether the drug benefits included in MedicareComplete are comprehensive enough is no different than the process you would engage in to assess the value of a stand-alone plan.
The first thing you need to do is determine if your medications are included in the MedicareComplete formulary. If they are not and you are set on Medicare Advantage you should start comparing formularies for plans available to you.
If your prescription requirements are significant and you are not finding Advantage plans with formularies that include your drugs, maybe you should consider a stand-alone plan. You probably require an enhanced formulary. Medicare Advantage plans do not generally include enhanced formularies.
Other things to consider when comparing Part D benefits include:
- Whether there is a deductible
- The copayment/coinsurance amounts
- Pharmacy network
- Mail order options
Enrolling in a Medicare Advantage plan with inadequate Part D benefits can negate any positive aspects of the medical benefits. When choosing MedicareComplete or any other plan it is important to focus on the Part D benefits and not get blinded by low premiums or low out-of-pocket costs for medical services. You must assess the plan as a whole.