What Makes a Medicare Advantage Prescription Drug (MAPD) Plan a Smart Choice?

Like many people, you may take a prescription medicine or two … maybe more. And those costs can really add up, especially people who are 65 or older and are on a fixed income. That’s why you might want to consider adding a prescription drug plan to your Medicare coverage.

It’s Easy to Get Medicare Prescription Drug Coverage

You may already know Original Medicare doesn’t cover the drugs you buy from a pharmacy. But you can easily get prescription drug coverage, known as a Medicare Part D Plan, from private companies in two ways:

1. A stand-alone Prescription Drug Plan (PDP), which you can add to Original Medicare or a Medicare Supplement insurance plan.
2. A Medicare Advantage plan (Part C) that includes prescription drug coverage.

About Medicare Advantage Prescription Drug Plans

A Medicare Advantage plan with prescription drug coverage, also called an MAPD plan, can be a great choice because it includes all the benefits of Medicare Parts A (hospital insurance) and B (medical insurance) as well as drug coverage.

Medicare Prescription Coverage and More in Simple, All-in-One Plans

MAPD plans are approved by Medicare to provide your Parts A and B benefits — plus they cover prescription drugs and extra benefits that Original Medicare doesn’t. By bundling everything together, these MAPD plans make controlling Medicare drug costs and managing all aspects of your medical care easier.

With an MAPD plan, you’ll also receive low monthly premiums, an annual limit on out-of-pocket costs, and additional options that could include wellness programs, fitness memberships, dental, vision and hearing benefits, and more.

Choosing the MAPD Plan That Fits Your Needs

When considering MAPD plans, you’ll want to take into account their coverage and their costs, which can include monthly payments, deductibles, copayments and/or a percentage of a service or drug’s overall cost.

To make the most of your MAPD plan’s Medicare prescription drug coverage, here are a few things to keep in mind:

• All MAPD plans have a list of covered drugs, known as a formulary. It’s required to include common types of drugs, but not specific drugs within each type. Check to make sure any medications you need are included in your plan’s drug list.
• MAPD drug lists place medications into three to six different “tiers” or levels of cost to you. Drugs listed in lower tiers may be generic and generally cost less than drugs listed in higher tiers.
• MAPD plans can specify which pharmacies you must use. If you get a prescription filled by a pharmacy that’s not in your plan, you may pay more or all of the cost.
• Find out if you can save by using a mail-order pharmacy, which typically supplies a two- or three-month refill for a single copayment.

Remember, prescription plans for Medicare (Part D) are optional and you don’t automatically get one with Original Medicare. You have to choose Medicare prescription coverage from a private company. It’s best to make your Part D choice during your Initial Enrollment Period, because if you wait more than 63 days you may be subject to a late enrollment penalty. And when you get Part D bundled into a Medicare Advantage plan that includes prescription drug benefits, your MAPD will give you valuable all-in-one coverage.

Please note: Some Medicare Advantage plans do not cover prescription drugs, so be sure the plan you choose is an MAPD plan if you want it to include prescription drug coverage.

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A CONSUMER’S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY OFFICE OR FROM THIS INSURER

Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Services provided by Empire HealthChoice Assurance, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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