There are four different parts to Medicare: Part A, Part B, Part C and Part D. Current and potential Medicare beneficiaries may find these labels confusing, but with the right knowledge, you can make an informed decision about which option might be the right fit your needs.
In this article, we’ll examine Medicare Part C (also commonly known as Medicare Advantage) vs. Medicare Part D (prescription drug coverage).
Medicare Part C is often referred to as Medicare Advantage. But the Medicare Advantage program is not just one universal plan. There are a number of different Medicare Advantage plans offered by insurance companies all over the country, though plan availability will depend on where you live.
Medicare Advantage plans can work similarly to traditional health insurance plans in that you pay a premium (in most cases) to belong to a plan and may then have cost-sharing responsibilities such as copays or coinsurance and a deductible. Plans typically have a provider care network.
There are three primary ways in which Medicare Advantage plans differ from Original Medicare (Medicare Part A and Part B):
Medicare Part D plans offer prescription drug coverage and are often referred to as a “Prescription Drug Plan,” or PDP. Like Medicare Advantage plans, Part D plans require that you pay a premium (in most cases) to belong to a plan, and you may also be responsible for paying copayments or coinsurance for covered prescription drugs as well as a deductible. And again, your plan may have a network of preferred pharmacies, and it may not.
Medicare Part D plans differ from Medicare Advantage plans in a number of ways, including:
Medicare Part D plans do not offer vision or dental coverage, in the way that some Medicare Advantage plans might. Part D plans provide coverage for prescription drugs only.
Medicare Advantage plans and Medicare Part D plans can be different in a number of ways.
As previously mentioned, a Medicare Advantage plan may cover services such as blood work, dental exams and hospital stays. By law, Medicare Advantage plans must cover everything that is covered by Medicare Part A (hospital insurance) and Part B (medical insurance). Medicare Part A still covers hospice care, even if you are enrolled in a Medicare Advantage plan.
Medicare Advantage plans may also cover vision and hearing care, or even prescription drugs. There are some Medicare Advantage plans that offer prescription drug coverage and some that don’t. 90 percent of Medicare Advantage plans will offer prescription drug coverage in 2019.1
Part D plans, on the other hand, cover only prescription drugs.
In order to be eligible for a Medicare Advantage plan, you must be enrolled in both Part A and Part B of Medicare (and you must continue to pay your Medicare Part B premiums in addition to your Medicare Advantage premium).
To become eligible for a Part D plan, you must only be enrolled in Part A or Part B (or both). You must continue to pay you Part B premiums along with your Part D premium.
Both types of plans may be available to people under 65 who qualify for Medicare because of a certain disability or illness. People with End-Stage Renal Disease (ESRD) generally may not sign up for a Medicare Advantage plan.
The coverage area for a Medicare Advantage plan is often based on your zip code or county of residence. Some Part D plans can encompass larger coverage areas and can even include multiple states on the same plan.
The cost of Medicare Advantage plans and Part D plans can also differ quite significantly.
The costs of any one particular plan can vary greatly from others.
For Medicare Advantage plans, costs can be determined largely by the array of services that are offered. When it comes to out-of-pocket expenses, there is an annual out-of-pocket limit for all Medicare Advantage plans . The out-of-pocket spending limit can vary from plan to plan.
Some Medicare Advantage plans do not have a deductible. Some plans may also have a $0 premium, though $0 premium plans may not be available in all locations.
Most Medicare Advantage plans use copays for patient cost-sharing. A copay is a flat-fee, as opposed to the percentage-based coinsurance.
For Part D plans, costs typically run concurrent with the four “tiers” in which drugs are categorized. The lowest tier drugs are considered the less expensive, such as generic drugs and the least expensive brand names. The highest tier drugs are typically specialty drugs and the most expensive brand name medications.
Part D plans may or may not have a deductible. If they do, it may not be more than $415 per year.4 Part D plans also contain a coverage gap, commonly known as the “doughnut hole.” The doughnut hole begins once you’ve spent $3,820 and lasts until you spend $5,100 out-of-pocket for the year in 2019. While you are in this doughnut hole, Part D plan coverage can vary.
The cost of both Medicare Advantage plans and Part D plans can also be influenced by the type of plan (HMO, PPO or others) and the local area in which they are sold.
The popularity of Medicare Advantage plans and Part D plans has been seemingly going in opposite directions in recent years.
According to the Kaiser Foundation, the average number of Medicare Advantage plans with drug coverage made available to each Medicare beneficiary will be 20 in 2019.1 The average Medicare beneficiary will have access to 27 Part D plans in 2019.2
There will be 2,734 Medicare Advantage plans available nationwide in 2019. A total of 901 standalone Medicare Part D plans will be available in 2019.
You are not allowed to be enrolled in a Medicare Advantage plan that offers prescription drug coverage and a Part D plan at the same time.
If you do not take any prescription drugs but want the additional benefits offered by a Medicare Advantage plan (such as hearing, vision and dental coverage), or if you take prescription medication and your drugs are covered by a Medicare Advantage plan, you might consider applying for a Medicare Advantage plan.
You might choose to enroll in a Part D plan if you have no need for the extra services that might be provided by a Medicare Advantage plan but you want prescription drug coverage.
If your Medicare Advantage plan does not offer prescription drug coverage, you can enroll in a Medicare Prescription Drug plan as well.
Enrollment is one area in which Medicare Advantage and Part D plans can be similar. Both types of plans utilize Medicare’s Initial Enrollment Period (IEP) along with the annual fall Open Enrollment Period, where you may join, change or drop coverage for each type of plan.
Contact a licensed insurance agent today by callingTTY Users: 711. Learn more about your health care and prescription drug coverage options and find the plan that makes the most sense for you.
1 Kaiser Family Foundation. Medicare Advantage 2019 Spotlight: First Look. (Oct. 16, 2018). Retrieved from www.kff.org/report-section/medicare-advantage-2019-spotlight-first-look-data-note.
2 CMS. Medicare Part D premiums continue to decline in 2019. (July 31, 2018). Retrieved from www.cms.gov/newsroom/press-releases/medicare-part-d-premiums-continue-decline-2019.
3 Kaiser Family Foundation. Medicare Part D: A First Look at Prescription Drug Plans in 2019. (Oct. 16, 2018). Retrieved from www.kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-prescription-drug-plans-in-2019.
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