What is a limitation that Mr. Lombardi faces regarding drug coverage when enrolled in an MA-only PPO plan?

When enrolled in an MA-only PPO plan, an individual like Mr. Lombardi cannot enroll in a standalone drug plan. This is because Medicare Advantage (MA) plans, which include MA-only PPO plans, generally provide integrated drug coverage. The structure of these plans is designed to offer both medical and prescription drug benefits under the same plan, meaning that enrollees are not permitted to have separate standalone drug plans that could overlap. This rule ensures that beneficiaries receive comprehensive coordinated care and prevents complexities that could arise from managing both an MA plan and a separate prescription drug plan.

Mr. Lombardi’s specific situation demonstrates this limitation, as enrolling in a standalone drug plan would contradict the guidelines governing MA plans, which aim to consolidate benefits and streamline patient care. Understanding this limitation is crucial for beneficiaries when considering their healthcare options, as it impacts their ability to access necessary medications and manage their overall health coverage effectively.