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Medicare prescription drug coverage

Within Medicare Part D, there are two plan types to choose from — prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MAPDs). Expand each question below to learn more about Medicare Part D coverage.

Medicare prescription drug coverage (Part D) is offered through private insurance companies, like Allina Health | Aetna Medicare. You can get Part D coverage through a stand-alone prescription drug plan (commonly referred to as a PDP) or some Medicare Advantage plans (commonly referred to as a MAPD or Part C).

A prescription drug plan (PDP) is a stand-alone Medicare Part D plan. PDPs only offer Part D and work together with your Original Medicare. This is a good option for someone who wants to stay in Original Medicare but add prescription drug coverage.

A Medicare Advantage prescription drug plan (or MAPD) is a plan — from a private insurer such as Allina Health | Aetna Medicare — that combines all your health coverage into one plan.

 

A MAPD plan includes:

 

  • Medicare Part A (hospital)
  • Medicare Part B (medical)
  • Medicare Part D (prescription)

 

Like other health plans, MAPDs come in various forms, including PPOs (preferred provider organizations).

  • Each plan has a drug list (formulary) that shows which drugs it will cover. Both generic and brand drugs are covered under Part D. Visit our formulary FAQ page to learn more.
  • A generic drug is a prescription drug that is approved by the Food and Drug Administration (FDA) as having the same active ingredient(s) as the brand-name drug. Generally, a “generic” drug works the same as a brand-name drug and usually costs less.
  • A brand-name drug is a prescription drug that is made and sold by the company that originally researched and developed the drug. A brand-name drug has the same active ingredients and formula as its generic version.

Here are some examples of what Part D prescription drug plans do not cover:

 

  • Drugs given in hospitals or doctors’ offices that are already covered under Part A or Part B
  • Any drugs not listed on a plan’s drug formulary (except in special circumstances)
  • Nonprescription drugs or prescription vitamins (other than prenatal vitamins). Examples include weight loss or weight gain, hair growth and/or erectile dysfunction drugs.

 

For a more complete list of drugs not covered by Medicare, please visit our Prescription drug formulary FAQ page.

Aetna Medicare Part D plans cover the shingles vaccine and some commercially available vaccines. Part D in general covers recommended adult immunizations when needed to prevent illness. Talk to your provider about which ones are right for you.

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