Certain types of Medicare Advantage plans may cover insulin through accompanying Medicare prescription drug coverage, also known as Medicare Part D. Medicare Advantage plans that include the option for prescription drug coverage are also known as MA-PD. If a Medicare Advantage plan type doesn’t offer prescription drug coverage, seniors may enroll in a standalone Part D plan in addition to their Medicare Advantage plan.
Types of Medicare Advantage Plans
There are five primary types of Medicare Advantage plans. They include:
- Health Maintenance Organization plans (HMOs)
- Preferred Provider Organization plans (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-for-Service plans (PFFS)
- Medical Savings Account plan (MSA)
During the Medicare enrollment process, it’s important that seniors seeking insulin coverage understand which Medicare Advantage plan types include MA-PD plans that cover Part D prescription drugs and which ones don’t. If seniors select a plan type that offers MA-PDs, they may not be able to enroll in a separate Part D plan that covers insulin even if they choose a plan that does not cover prescription drugs. Also, seniors should note that all plan types may not be available in their area.
Deciphering Which Medicare Advantage Plan Types Cover Prescription Drugs
Of the five Medicare Advantage plan types, only MSAs don’t offer coverage for prescription drugs. Seniors who enroll in an MSA must also enroll in a separate Medicare Part D plan if they wish to receive coverage for insulin and other prescription drugs. With the other four plan types, the rules vary slightly and are outlined below.
HMOs and PPOs
HMOs and PPOs are the most common Medicare Advantage plan types, and they usually do include prescription drug coverage in the form of MA-PDs. However, some individual plans may not. Seniors who plan to enroll in an HMO or PPO must select one that offers prescription drug coverage if they would like to have insulin coverage. If seniors enrolled in a separate Part D plan in addition to an HMO or PPO plan, they would be disqualified from their Medicare Advantage plan and enrolled only in Original Medicare and Medicare Part D.
Some PFFS plans include prescription drug coverage, but seniors who enroll in this plan type may enroll in a separate Part D plan if their selected plan doesn’t cover prescription drugs.
All SNPs include prescription drug coverage. Seniors who select this plan type may not enroll in a separate Medicare Part D plan.
Confirming Medicare Advantage Insulin Coverage
While most MA-PD and Part D plans may cover insulin, it’s important to verify coverage with the specific plan before enrolling. Additionally, an MA-PD or Part D plan may include coverage for insulin-related supplies such as gauze, syringes, needles and alcohol swabs.
Finally, seniors should note that MA-PDs and Part D plans don’t directly cover insulin administered with an insulin pump. Pumps are considered durable medical equipment and may be covered, along with insulin, through Medicare Part B. Seniors enrolled in Medicare Advantage are by default also enrolled in Medicare Parts A and B.