Medicare Part D is Medicare’s prescription drug coverage that’s offered to help with the cost of medication.
Medicare Part C (Medicare Advantage plans) is a health plan choice, similar to a PPO or HMO, offered by private companies approved by Medicare. Most Medicare Advantage plans include Medicare Part D.
Part C and Part D are two of the four primary parts of Medicare:
- Medicare Part A (hospital insurance)
- Medicare Part B (medical insurance)
- Medicare Part C (Medicare Advantage, or private insurance plans)
- Medicare Part D (prescription drug coverage)
Can you have both Medicare Part C and Part D?
You can’t have both parts C and D. If you have a Medicare Advantage plan (Part C) that includes prescription drug coverage and you join a Medicare prescription drug plan (Part D), you’ll be unenrolled from Part C and sent back to original Medicare.
Medicare Part C, also known as Medicare Advantage, was established in the Balanced Budget Act of 1997. It offers a way for you to have more choices for healthcare coverage and to get more comprehensive healthcare coverage.
Medicare Part C provides all the benefits of Medicare parts A and B. These plans also often offer additional benefits, such as dental, vision, and prescription drug coverage.
For Medicare Part C, the Centers for Medicare and Medicaid Services (CMS) contracts with public or private organizations to offer a variety of health plan options, such as:
- coordinated care plans, like:
- PPOs (preferred provider organizations)
- HMOs (health maintenance organizations)
- PSOs (provider-sponsored associations)
- medical savings account plans
- private fee-for-service plans
- religious fraternal benefit plans
When considering Medicare Part C, along with comparing benefits, compare costs, too. Typically, you’ll pay a separate monthly premium, but not all Medicare Advantage plans have monthly premiums.
If you’re enrolled in original Medicare (parts A and B), you’re eligible to sign up for a Medicare Advantage plan.
Medicare Part D is an optional benefit for all people who have Medicare. It adds drug coverage to:
- original Medicare
- some Medicare cost plans
- some Medicare private fee-for-service plans
- medical savings account plans
The monthly premium you pay for Medicare Part D varies by plan. Higher-income consumers may pay more for this coverage.
You’re eligible for Medicare Part D when you become eligible and sign up for Medicare.
If you didn’t sign up for Medicare Part D when you were first eligible, you may be required to pay a late enrollment penalty for the entire time you continue with Part D.
You can avoid the late enrollment penalty if you have other creditable prescription drug coverage, such as from a union or employer that pays at least as much as Medicare’s coverage.
You can also avoid it if you qualify for Medicare’s Extra Help program by meeting certain income and resource limits.
To help you get specific information on available drug plans (Medicare Part D) and Medicare Advantage plans (Part C), the CMS has a Medicare plan finder at Medicare.gov. You have a choice of using this plan finder in either English or Spanish.
If you’re eligible for Medicare and want or need prescription drug coverage, you can get it through Medicare Part D. Or you can also get it through a Medicare Advantage plan (Medicare Part C) that offers coverage for prescription medication.
Before committing to one or the other, review cost and coverage details to make sure you have a plan that best suits your healthcare needs and your budget.
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