PDP vs. MA-PD Plans
Medicare Part D, as a whole, is prescription drug coverage for individuals with Medicare. Within it, there are plans to choose from – Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MA-PDs).
A stand-alone Medicare Part D plan is referred to as a Prescription Drug Plan (PDP). Individuals are eligible to enroll in a PDP if they are entitled to Medicare benefits under Medicare Part A and/or Medicare Part B.
This form of insurance helps pay for a variety of prescription drugs, including:
- Outpatient prescription drugs
- Some medical supplies not covered by Part A or Part B
Those who enroll in a Medicare Advantage plan (Part C) can also choose a plan with prescription drug coverage. A Medicare Advantage Prescription Drug plan (MA-PD) is a Medicare Advantage (Part C) plan that includes prescription drug coverage.
MA-PD plans are offered by private companies that contract with Medicare to provide Part A, Part B and Part D benefits. MA-PDs include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service (PFFS) plans, or Medicare Medical Savings Account (MSA) plans. Some Medicare Advantage plans may cover more services not included in Part A or B, like vision, dental or hearing coverage.
PDP and MA-PD Drug Coverage
PDP and MA-PD plans cover the most commonly prescribed drugs. But each specific Part D plan may determine which drugs are covered. The covered drugs are included in the plan’s formulary, or list of drugs.
PDP plans do not include the coverage of drugs covered under Part A or Part B plans (drugs given during inpatient hospital stays or doctor office visits), non-prescription and certain prescription vitamins not covered by Medicare (excluding prenatal vitamins), or drugs that are not included on the plan’s formulary.