Understanding Original Medicare vs. Medicare Advantage
If you’re one of the millions of Americans who relies on Medicare, you know there’s a lot of information to take in about your coverage options. To find the best plan for your needs, it’s important to understand the different types of Medicare and how each type handles prescription drug coverage.
When you enroll in Medicare, you can choose between Original Medicare and Medicare Advantage (also known as Medicare Part C). Original Medicare does not include drug coverage, requiring you to purchase a stand-alone prescription drug plan (PDP). In contrast, most Medicare Advantage plans include drug coverage, and those that do are called Medicare Advantage prescription drug (MAPD) plans.
If you’re already enrolled in a Medicare Advantage plan, you can take advantage of the Medicare Advantage Open Enrollment Period from Jan. 1 to March 31. During this time, you can select a different Medicare Advantage plan or switch to Original Medicare depending on your needs.
Medicare parts down to the letter
Medicare is broken down into parts that cover different services. Before choosing a plan, it’s important to know what each part covers:
- Part A covers hospital stays, skilled nursing, hospice care and some home healthcare.
- Part B covers doctor visits, outpatient care, preventive services and medical supplies.
- Part C is another name for Medicare Advantage.
- Part D covers prescription drugs.¹
How to get Medicare Part D drug coverage
Whether you currently take prescriptions or want to prepare for the future, ensuring you have Part D drug coverage can help you get the most out of your Medicare benefits. Below are some pros and cons to consider to help you find the best plan for your needs.
Original Medicare and PDPs
Original Medicare only covers Part A and Part B. To get Part D drug coverage, you need to purchase a stand-alone prescription drug plan (PDP). Review Humana’s PDPs.
Pros of Original Medicare:
- Includes Part A and Part B coverage
- Allows you to see any doctor in the U.S. that takes Medicare
Cons of Original Medicare:
- Does not include Part D prescription drug coverage
- Requires a separate plan for vision, hearing and dental care²
Medicare Advantage and MAPD plans
Medicare Advantage plans include Part A, Part B and usually Part D. When a Medicare Advantage plan includes Part D, it’s called a Medicare Advantage prescription drug (MAPD) plan. Review Humana’s MAPD plans.
Pros of Medicare Advantage (Medicare Part C):
- Includes Part A and Part B coverage
- Offers MAPD plans, which include Part D drug coverage
- Can cover vision, hearing and dental care
- Has low or $0 monthly premiums for many plans
Cons of Medicare Advantage:
- May require that you use doctors or pharmacies in the plan’s network²
- May require that you get a referral to see a specialist³
Resources to help you choose a Medicare plan
We know choosing a Medicare plan can feel overwhelming, and we’re here to help. Here are some tips and resources to compare plans:
- Compare out-of-pocket costs, such as premiums, deductibles and copays to find a plan in your budget.
- Check the Humana Drug List to see if your prescriptions are included on your plan’s formulary.
- Review the plan’s network (if any) to see if your preferred doctors and pharmacies are in network.
- Be aware of the Part D coverage gap and be prepared with a supplemental plan if needed.
- Take advantage of the Extra Help program if you qualify to get help paying for your prescriptions.
Remember that costs, benefits and formularies may change each year. To see what’s changed, check your plan’s Annual Notice of Change booklet or Medicare plan documents. You can also see some of Humana’s prescription drug coverage updates for 2023.
How CenterWell Pharmacy helps you maximize your drug coverage
Whichever Medicare plan you choose, CenterWell Pharmacy® is here to help you get the most out of your prescription drug benefits.*
If a prescription you need isn’t covered, we can work with your prescriber to find an alternative. We also double-check every order for accuracy and any potential drug interactions to help keep you safe.
In addition, our convenient mail-order service helps you save a trip to the pharmacy and includes easy order tracking. Plus, you can get up to a 90- or 100-day supply of qualified prescriptions where applicable—which often results in savings compared to a 30- or 60-day supply.
You can transfer or start a new prescription today. Once your prescriber approves it, we’ll mail your medicine safely and securely to your door in 7–10 days.
And if you need help or have questions, please don’t hesitate to contact us. Our Customer Care specialists and expert pharmacists are happy to help!
Sources:
- “What’s Medicare?” Medicare.gov, last accessed Jan. 25, 2023, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare.
- “Your Medicare coverage choices,” Medicare.gov, last accessed Jan. 25, 2023, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices.
- “How Do Medicare Advantage Plans Work?” Medicare.gov, last accessed Jan. 25, 2023, https://www.medicare.gov/health-drug-plans/health-plans.
Disclaimers
Humana is a Medicare Advantage [HMO, PPO, and PFFS] organization [and a stand-alone PDP prescription drug plan] with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.
* Other pharmacies are available in the Humana network.
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