|Medicare Prescription Drug Coverage (Part D)||
Original Medicare or Medicare Advantage?
All Medicare beneficiaries have the option of getting their health care, including their prescription drug coverage, in one of two ways: through Original Medicare or by enrolling in a Medicare Advantage plan. People with MS should carefully consider the pros and cons of both options before committing to either one, especially since most people are prohibited from switching to a different plan until the following year once enrollment into a plan has occurred.
There are many different types of Medicare Advantage Programs, although most are health maintenance organizations (HMOs) or preferred provider organizations (PPOs) that limit you to their ‘in network' doctors and hospitals. Some newer types of Medicare Advantage plans will cover more out-of-network care, but generally have higher out-of-pocket costs.
It is important to be careful before enrolling in a Medicare Advantage Plan to ensure that you are able to access your hospitals, doctors, and, if considering a MA plan that includes prescription drugs, includes convenient pharmacies. Make sure that you are not limiting your coverage by getting into a plan that only has a few appropriate doctors who accept the specific plan.
Example: Joe called looking for advice on Medicare Advantage Plan ‘X'. He said he saw a TV commercial about it and it sounded really good. The questions he should be asking are: What makes this plan right for me? What kind of plan is it? Can I see any doctor or would I need a referral to go outside of the network? How about pharmacies and hospitals? Are all of my medications going to be covered?
Note that all Medicare prescription drug plans, including both stand alone prescription drug plans and Medicare Advantage Drug Plans, require their members to fill their prescriptions through certain participating pharmacies, and all plans must include a mail order pharmacy. When you begin comparing plans, the location and convenience of their participating pharmacies should be considered.
|Last updated November 26, 2007|