Standalone Part D vs Medicare Advantage Drug Coverage

Two Ways to Get Medicare Drug Coverage

You can get prescription drug coverage through a standalone Part D plan with Original Medicare, or through a Medicare Advantage plan that includes drug coverage.

Each approach has different benefits, costs, and restrictions that affect your overall Medicare experience.

Standalone Part D Plans

How Standalone Part D Works

You keep Original Medicare (Parts A and B) and add a separate Part D plan for prescription coverage:

• Choose from dozens of Part D plans in your area
• Works with any Medicare supplement plan
• Coverage follows you anywhere in the US
• Can change plans during Open Enrollment
• Plans compete solely on drug coverage and cost

Standalone Part D Costs

Typical Part D plan costs:

• Monthly premium: $7-$100
• Annual deductible: $0-$545
• Copays vary by drug tier and plan
• Coverage gap protection in 2025
• Catastrophic coverage after $8,000 in costs

Medicare Advantage with Drug Coverage

How MA-PD Plans Work

Medicare Advantage plans with prescription drug coverage (MA-PD) provide all Medicare benefits in one plan:

• Combines medical and drug coverage
• Often includes extras like dental and vision
• May have $0 monthly premium
• Network restrictions apply to pharmacies
• Coverage primarily in your local area

MA-PD Cost Structure

Typical MA-PD costs:

• Monthly premium: $0-$80 (many are $0)
• Drug deductible: Often $0
• Copays: $0-$50 per prescription
• Combined medical/drug out-of-pocket maximum

Key Differences

Plan Selection

Standalone Part D: Choose medical and drug coverage separately, optimizing each for your needs

MA-PD: Medical and drug coverage bundled together; must accept both or neither

Geographic Coverage

Standalone Part D: Works nationwide with any Medicare provider

MA-PD: Limited to plan's service area and pharmacy networks

Flexibility

Standalone Part D: Can change drug plans without affecting medical coverage

MA-PD: Changing plans affects both medical and drug coverage

Drug Coverage Comparison

Formulary Competition

Standalone Part D: Plans compete primarily on drug coverage, often resulting in better formularies

MA-PD: Drug coverage is secondary to medical benefits, may have more restrictions

Pharmacy Networks

Standalone Part D: Usually larger pharmacy networks, including major chains and mail order

MA-PD: May have smaller pharmacy networks with preferred cost tiers

Prior Authorization

Standalone Part D: Generally fewer prior authorization requirements

MA-PD: May have more utilization management and restrictions

Cost Comparison Examples

Scenario 1: Low Drug Costs ($200/month)

Original Medicare + Part D:

• Part D premium: $30/month
• Drug copays: $50/month
• Monthly total: $80

Medicare Advantage with drugs:

• Plan premium: $0/month
• Drug copays: $60/month
• Monthly total: $60

MA-PD saves $20/month

Scenario 2: High Drug Costs ($800/month)

Original Medicare + Part D:

• Part D premium: $50/month
• Drug copays: $200/month (after coverage gap protection)
• Monthly total: $250

Medicare Advantage with drugs:

• Plan premium: $0/month
• Drug copays: $400/month
• Monthly total: $400

Part D saves $150/month

Who Should Choose Standalone Part D

High Drug Costs

People with expensive medications often find better coverage and lower costs with standalone Part D plans.

Frequent Travelers

Part D plans work nationwide, while MA-PD plans may have limited pharmacy networks outside your area.

Those with Medicare Supplements

If you have a Medigap plan, you need standalone Part D coverage for prescription drugs.

People with Rare Conditions

Specialty drug coverage is often better with standalone Part D plans that compete specifically on drug benefits.

Who Should Choose MA-PD Plans

Low Drug Costs

People who take few or inexpensive medications often find MA-PD plans provide good value.

Those Who Want Simplicity

Having medical and drug coverage in one plan simplifies enrollment and plan management.

Budget-Conscious Seniors

Many MA-PD plans have $0 premiums and include extras like dental coverage.

Local-Focused Individuals

If you stay in your local area and use preferred pharmacies, MA-PD networks may work fine.

Important Considerations

Late Enrollment Penalties

You need creditable drug coverage to avoid penalties. Both options provide this protection.

Plan Changes

You can switch between these approaches during Open Enrollment, but consider any medical underwriting requirements for supplements.

Drug Coverage Gaps

Both types of plans have eliminated the coverage gap for most beneficiaries in 2025.

Making Your Decision

Analyze Your Medications

Use Medicare's Plan Finder to compare how your specific drugs are covered under different options.

Consider Your Overall Medicare Strategy

If you want Original Medicare with a supplement, you'll need standalone Part D. If you prefer all-in-one coverage, consider MA-PD.

Think About Future Needs

Your drug needs may change. Which approach gives you better options for adapting to changes?

The Bottom Line

Standalone Part D plans often provide better drug coverage and more flexibility, especially for people with expensive medications.

Medicare Advantage with drug coverage can offer good value for healthy seniors with simple drug needs who want all-in-one convenience.

Your choice should align with your overall Medicare strategy and specific prescription drug needs.