Things to Know About Prescription Advantage

Prescription Advantage, administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs, is a prescription drug insurance plan that is available to Massachusetts residents age 65 and older, as well as younger individuals with disabilities who meet income and employment guidelines.

Prescription Advantage offers two types of prescription drug coverage. 

For Individuals with Medicare: Prescription Advantage provides supplemental assistance, based on income, for its members with Medicare prescription drug coverage. Medicare is the primary drug insurance for Prescription Advantage members. Prescription Advantage is a secondary payer.  Depending on income, Prescription Advantage may help pay all or part of the Medicare prescription drug plan's drug co-payments. Prescription Advantage will also provide an out-of-pocket spending limit. Once this limit is reached, Prescription Advantage will cover drug co-payments for the remainder of the plan year.

For Individuals With Creditable Coverage: Prescription Advantage members enrolled in creditable coverage plans, coverage that is equal to or better than Medicare prescription drug coverage, may receive assistance with plan co-payments. For members in these plans, as for Medicare prescription drug plans, Prescription Advantage is the secondary payer; the creditable coverage plan is the primary payer.

For Individuals Without Medicare: Prescription Advantage offers members, who do not qualify for Medicare, primary prescription drug coverage. This coverage has no monthly premium. Depending on income, members will pay a co-payment for prescription drugs and will have an annual out-of-pocket spending limit and quarterly deductible. Once this annual out-of-pocket limit is reached, Prescription Advantage will cover drug co-payments for the remainder of the plan year.

Please Note: The legislation which funds Prescription Advantage requires the Executive Office of Elder Affairs to operate the program within its appropriation for the current fiscal year; thus, during the course of the year, the Plan may be required to impose cost containment measures.