Most Medicare Advantage (Part C) plans include prescription drug (Part D) coverage. These are called Medicare Advantage Prescription Drug (MA-PD) plans. Each has its own unique list of covered drugs, pharmacy network, and costs. Checking these details can help you find an option that covers the medications you take regularly, at a price you can afford.
Even if you’re happy with your current drug plan, it’s always a good practice to review your coverage annually during Medicare Open Enrollment, Oct. 15–Dec. 7. Your prescriptions, health needs, finances, and plan coverage can all look different for the upcoming year.
"What worked for you last year may not be the best choice moving forward," said Ryan Ramsey, Associate Director of Health Coverage and Benefits at NCOA. "Your health may have changed, or you may be taking different medications. Maybe your budget is a bit tighter this time around. These can all mean that better options are available."
Any changes you make to your prescription drug coverage will become effective on Jan. 1.
Do all Medicare Advantage plans include drug coverage?
No. Most Medicare Advantage plans include prescription drug coverage through Medicare Part D, but some do not. As of February 2026, 56% of Part D beneficiaries (57% of enrollees) were enrolled in Medicare Advantage plans with prescription drug coverage1—including health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, and special needs plans (SNPs).
Medicare Medical Savings Account (MSA) plans do not offer Part D coverage. If you join an MSA plan and want prescription drug benefits, you’ll have to enroll in a separate Medicare drug plan. This is also true for private fee-for-service (PFFS) plans, which may or may not cover prescription drugs.
It’s important to know what prescriptions are generally covered by an MA-PD plan and at what tier, what your out-of-pocket costs might look like, and how to use your plan at the pharmacy. You should also be aware of any cost-saving opportunities that may be available. This will help you make smart, informed coverage decisions for yourself or someone you help provide care for.
How does prescription drug coverage work with Medicare Advantage plans?
All MA-PD plans must cover a broad range of prescription drugs that Medicare beneficiaries take. This includes most medications in protected drug classes, such as those used to treat cancer, depression, and HIV/AIDS.
This prescription drug coverage is essential—especially if we're 65 or older and dealing with one or more chronic health conditions. A reported 90% of us take at least one prescription drug on a regular basis; and 43% take at least five.2 A good drug plan can help greatly lower the costs of the medications we need to stay healthy and feel our best.
What is a formulary?
A formulary is a health plan’s list of covered prescription drugs. Drugs are often grouped into levels called tiers, which help determine what you pay.
In an MA-PD plan, the formulary shows you:
- If your individual prescriptions are covered
- What tier a drug falls under (lower-tier drugs usually cost less, while higher-tier drugs cost more)
- How much a drug costs
A formulary covers both generic and brand-name drugs. It will have two or more of the most commonly prescribed drugs for each class and category. This helps make it easier for you to get the prescription drugs you need. If your MAPD plan’s formulary does not include the exact drug you need, a comparable drug may be available. In cases where no covered drugs meet your medical requirements, you can file for an exception.
MA-PD plans may update their list of covered drugs as new medical information becomes available and new drugs are released into the marketplace. Similarly, plans might remove prescription drugs from their formulary if for some reason they are no longer considered safe. It’s important to note that formularies can change, so you should review your plan’s prescription drug coverage every year.
How do I use my Medicare Advantage prescription drug plan at the pharmacy?
When you’re using your MA-PD plan for the first time in person at the pharmacy, you’ll want to bring with you:
- Your red, white, and blue Medicare card
- A photo I.D. (such as a valid driver’s license)
- Your plan membership card
Having these items will allow the pharmacy to get you set up in their system, which will make prescription drop-offs and pick-ups faster and easier. Do you have certain medications you take regularly? Depending on your MA-PD plan, your pharmacy may be able to give you up to three months’ worth of covered drugs in one visit to save you trips out of the house.
If you have no transportation or it’s difficult to leave your home, a mail-order drug program may be another option. Certain MA-PD plans allow you to get a three-month supply of covered medications shipped directly to your door.
How can I save money on prescriptions through Medicare Advantage?
Prescription medications can be expensive, but there are a number of ways to cut down on your drug costs:
- Choose generic drugs whenever possible: Generic medications can cost significantly less than their brand-name counterparts—and they work just as well. When your health care provider writes you a prescription, ask them to allow the pharmacy to substitute a generic drug whenever appropriate.
- Use a preferred pharmacy: Some Medicare Advantage plans have contracts with in-network (“preferred”) pharmacies, which provide members with discounted services and supplies. Be sure to fill your prescriptions at in-network pharmacies to ensure they’re covered. If you don’t know which pharmacies are in network, check with your plan.
- Order a larger supply: Whether you get it from your local pharmacy or through a mail-order program, purchasing a three-month supply of your medications may cost less than filling the prescription each month. Some plans, like Aetna, offer a 100-day supply on select prescription drugs. Aetna MA-PD members can take advantage of this new, larger supply with no increase in copay/coinsurance.
- Shop around: Not all pharmacies charge the same for prescription drugs—even those that are in-network. If a drug isn't covered by your MA-PD plan, or if you haven't yet met your deductible, call different pharmacies near you to ask about their cost for a medication.
- See if you qualify for Part D Extra Help: The Part D Low Income Subsidy (LIS, or "Extra Help") is a program that covers some prescription drug plan costs, including Part D premiums, deductibles, and copayments. Its estimated average annual value is $5,700 per person. To be eligible for Extra Help, you must satisfy eligibility requirements, such as meeting certain income limits. If you're enrolled in one of the Medicare Savings Programs (MSPs), you automatically qualify for Extra Help.
Learn more in our Medicare Advantage guide.
Get expert help choosing a Medicare Advantage plan that covers your prescriptions
Ramsey notes that due to a combination of rising health care costs, insurer financial and market decisions, and federal payment policies, Medicare Advantage plan enrollees will see many changes for 2027—from increased cost sharing to fewer extra benefits.
“Before selecting coverage, you’ll want to figure out how any new changes might affect your budget and your access to important health care services,” he advised. “Look beyond the monthly premium, since that’s only part of the picture. Take the time to compare copayments, provider networks, drug formularies, extra benefits, and the annual maximum out-of-pocket limit.”
Your State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling. A SHIP counselor can help you compare Medicare Advantage plans for the 2027 plan year, check if your medications are covered, and understand your out-of-pocket costs. Find your local SHIP here.
Frequently Asked Questions (FAQ)
How do I check if my Medicare Advantage plan covers my prescriptions?
Check your plan’s list of covered drugs, called its formulary. You can usually find it on the plan’s website or call the member services number on the back of your insurance card.
Look up each medication’s exact name, dose, and form (such as a tablet or liquid). See what you’ll pay, which pharmacies you can use, and whether you need approval before the plan will cover it.
Can my Medicare Advantage plan change its covered drugs?
Yes. Your Medicare Advantage plan can change its list of covered drugs (formulary). Changes often happen at the start of a new year, but some can happen during the year. Your plan generally must notify you in advance if a change affects a drug you take.
If your medication is no longer covered, ask your prescriber about a covered alternative or help requesting an exception.
Can I use any pharmacy with Medicare Advantage?
You usually need to use a pharmacy in your Medicare Advantage plan’s drug coverage network. If you use an out-of-network pharmacy, your plan may not cover the prescription, except in certain situations.
You may pay less at a preferred pharmacy within the network. Check your plan’s pharmacy directory or call member services before filling your prescriptions.
Sources
1. KFF. Analyzing Changes in Medicare Part D Enrollment for 2026. March 3, 2026. Found on the internet at https://www.kff.org/medicare/analyzing-changes-in-medicare-part-d-enrollment-for-2026/
2. J. Mark Ruscin, PharmD, FCCP, BCPS, et al. Aging and Medications. Merck Manual. April 2025. Found on the internet at https://www.merckmanuals.com/home/older-people-s-health-issues/aging-and-medications/aging-and-medications
