Doctors, pharmacies and drug coverage: Where to start

We hear it all the time: “The most important thing for me at this age is to keep my care with the same provider and pharmacy I know and trust,” and we understand. When you’ve built a relationship with a care team and are comfortable in your routine, you don’t necessarily want to shift how you get care and pharmacy services simply because you now qualify for Medicare.

Here’s what you need to know about doctors, pharmacies and drug coverage with Medicare Advantage.

Can I find an Medicare Advantage option that lets me keep the same doctor or pharmacy?

Directories will be your source of truth for both doctors and pharmacies. Searchable directories help you find which doctors, providers and pharmacies are in or out of your network with your plan or the plan you are considering.

By reviewing a health insurance company’s directory before enrolling, you can see if your current providers and pharmacy are included in your coverage. Sanford Health Plan has an Medicare Advantage online directory for your convenience: Search our directory here.

You can also contact your plan to request a provider directory once enrolled.

What is a network, and why is understanding your network important?

Understanding your plan’s network helps ensure you get care at the lowest cost. A health insurance network is a group of health care providers who your plan contracts with to provide services for a set rate.

With some Medicare Advantage plans, when you choose your primary care doctor, you are also selecting your hospital and specialty networks.

It is important to remember that an Medicare Advantage plan can add or remove providers from its network at any time, and a doctor may choose to leave an Medicare Advantage plan’s network at any time as well. Should this occur, you will need to select a new in-network provider to get covered services.

Though networks may change, your Medicare Advantage plan is required to protect you from health care interruptions. Your plan will ensure you have adequate access to the same services as any provider who leaves the network.

Do all plans offer network coverage in the same way?

There are different types of health plans. Each is unique and meets different needs.

Preferred provider organization (PPO) plans

With a PPO plan, you can get your health care and services from any in-network doctor, health care provider and hospital. You can also choose to receive care and services from doctors, health care providers and hospitals not in the plan’s network, but the cost may be higher.

Health maintenance organization (HMO) plans

In most HMO plans, you must get your care and services from in-network doctors, health care providers and hospitals, except for emergency care and out-of-area urgent care or dialysis. You will need to choose an in-network provider as your primary care doctor.

Do plans disclose the prescription medication they cover?

You can find the prescription medications covered by your plan using your plan’s formulary. A formulary is a list of prescription drugs covered by a prescription drug plan or another health insurance plan offering prescription drug benefits.

Formularies can change monthly, so if you take a prescription medication regularly, you will need to check your plan’s formulary frequently to confirm coverage.

Formularies and prescription drug coverage through Sanford Health Plan: Learn more.

What other medication benefits are offered through an Medicare Advantage plan with Sanford Health Plan?

With an MA plan from Sanford Health Plan, members receive a quarterly amount – up to $70 – to purchase approved nonprescription medications and health-related items, such as over-the-counter pain medication and bandages.

Our Medicare Advantage plans offer more: Discover our added benefits.

To see what’s included in Original Medicare, a Sanford Health Plan MA plan or another plan you are considering, download our benefits comparison worksheet. It offers a side-by-side comparison so you can weigh each option to choose the right plan for you.

For more information or to speak with a licensed agent about enrolling, call (888) 535-4831 between 8 a.m. and 8 p.m. CT on Monday through Friday, excluding holidays.

Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.



CMS ID Number: H8385_458-463-618 Article Directories -PY2022-ND-SD_C, H3186_458-463-618 Article Directories -PY2022-MN_C Last Updated On: 3.31.23 at 10:30 AM

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