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AHIP Medicare - Medicare Advantage and Prescription Drugs

Healthcare4 CardsCreated 4 months ago

Organizations offering coordinated care Medicare Advantage plans must provide at least one plan with prescription drug coverage (MA-PD) in each service area. MA PFFS plans, however, are not required to offer drug coverage, and enrollees in PFFS plans without Part D can join a separate Part D plan.

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Does an organization offering coordinated care MA plans have to offer an MA plan with prescription drug coverage?

Yes. An organization offering coordinated care MA plans must offer at least one MA plan with prescription drug coverage (know as an MA-PD plan) in every service area.

NOTE: If a beneficiary enrolls in an MA plan that includes Part D prescription drug coverage (an MA-PD plan), the beneficiary can only receive Part D drug coverage through that plan.

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Key Terms

Term
Definition

Does an organization offering coordinated care MA plans have to offer an MA plan with prescription drug coverage?

Yes. An organization offering coordinated care MA plans must offer at least one MA plan with prescription drug coverage ...

Are MA PFFS plans required to offer prescription drug coverage?

No, MA PFFS plans have the option of offering prescription drug coverage but are not required to do so.
- An individu...

Are MA MSA plans allowed to offer prescription drug coverage?

NO. MA MSA plans are prohibited from offering prescription drug coverage If an MSA member wants prescription drug covera...

f a beneficiary enroll in an mA plan that is an HMO or PPO plan that does not include Part D coverage, can the beneficiary join a stand-alone Prescription Drug Plan (PDP)?

No. If a beneficiary enrolls in an MA plan that is an HMO or PPO plan that does not include Part D coverage, the benefic...

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AHIP Medicare - Medicare Advantage and Prescription Drugs
TermDefinition

Does an organization offering coordinated care MA plans have to offer an MA plan with prescription drug coverage?

Yes. An organization offering coordinated care MA plans must offer at least one MA plan with prescription drug coverage (know as an MA-PD plan) in every service area.

NOTE: If a beneficiary enrolls in an MA plan that includes Part D prescription drug coverage (an MA-PD plan), the beneficiary can only receive Part D drug coverage through that plan.

Are MA PFFS plans required to offer prescription drug coverage?

No, MA PFFS plans have the option of offering prescription drug coverage but are not required to do so.
- An individual enrolled in an MA PFFS plan that does not include a Part D benefit may enroll in a PDP, even if under the same MA contract, the organization offers another PFFS plan that includes a Part D benefit.

Are MA MSA plans allowed to offer prescription drug coverage?

NO. MA MSA plans are prohibited from offering prescription drug coverage If an MSA member wants prescription drug coverage, the member must enroll in a stand-alone PDP.

f a beneficiary enroll in an mA plan that is an HMO or PPO plan that does not include Part D coverage, can the beneficiary join a stand-alone Prescription Drug Plan (PDP)?

No. If a beneficiary enrolls in an MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary CANNOT join a stand-along Prescription Drug Plan (PDP).
– Enrollees in certain employer/Union retiree group plans may have different options.