Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
The correct answer and explanation is :
Correct Answer:
Mrs. Chi cannot enroll in a Medicare Advantage Medical Savings Account (MA MSA) plan and have prescription drug coverage through the MA MSA itself. MA MSA plans do not offer prescription drug coverage. If she enrolls in an MA MSA plan, she would have to disenroll from her standalone Part D plan, but she could enroll separately in a new standalone Part D plan to maintain prescription drug coverage.
Detailed Explanation (300+ words):
Mrs. Chi is currently enrolled in Original Medicare (Parts A and B) along with a standalone Medicare Part D plan for prescription drug coverage. Now, she is interested in enrolling in a Medicare Advantage Medical Savings Account (MA MSA) plan, which is a unique type of Medicare Advantage (Part C) plan.
An MA MSA plan has two components:
- A high-deductible health plan that covers Medicare services after the deductible is met.
- A medical savings account where Medicare deposits money annually. Mrs. Chi can use these funds to pay for qualified medical expenses before she meets the plan’s deductible.
However, MA MSA plans do not offer prescription drug coverage. This is a key limitation compared to other types of Medicare Advantage plans like HMOs or PPOs. If Mrs. Chi chooses to enroll in an MA MSA, she would have to disenroll from her current standalone Part D plan first because beneficiaries cannot have a Part D plan while on Original Medicare and an MA plan simultaneously.
Once she is enrolled in the MA MSA plan, she would then need to separately enroll in a new standalone Medicare Part D plan to maintain prescription drug coverage. Fortunately, CMS (Centers for Medicare & Medicaid Services) allows beneficiaries who enroll in MA MSA plans to still obtain Part D coverage through a standalone plan.
Important Note: If she fails to get a new Part D plan, she would be without drug coverage, and later enrollment could subject her to a late enrollment penalty.
In advising Mrs. Chi, you should explain:
- MA MSAs don’t include drug coverage.
- She must disenroll and then separately enroll in a new Part D plan if she wants prescription coverage.
- Timing is important: enrolling during the appropriate Medicare enrollment period avoids gaps or penalties.