Medicare Advantage Prescription Drug Plan (MAPD)
Medicare Advantage (MA) is a type of Medicare insurance that is sold by private insurance companies. Some of these plans combine health insurance benefits and prescription drug coverage into one comprehensive package called a Medicare Advantage Prescription Drug (MAPD) plan.
Medicare Advantage Prescription Drug plans, like all Medicare Advantage plans, are legally required to cover everything that Original Medicare (Part A and Part B) covers, with the exception of hospice care. In addition to Medicare Part D prescription drug coverage, many of these plans can include other benefits such as vision and dental, hearing, and access to wellness programs (like Silver Sneakers, for example).
Medicare Advantage Prescription Drug plan formulary
Each Medicare Advantage Prescription Drug plan has a documented list of medications that they cover, called a formulary. MAPD plans must offer two or more medications within each category (e.g. antidepressant, antibiotic), and the prescriptions are placed into tiers that then determine pricing. For example, generic prescriptions are often in a lower tier (and often cost less to obtain), while brand-name drugs are placed into a higher tier (and usually cost more).
Enrolling in a MAPD plan
In order to qualify for MAPD enrollment, a beneficiary must be entitled to Medicare Part A and enrolled in Part B, live within the plan's designated network, and not have been diagnosed to have End Stage Renal Disease (ESRD) prior to completing the enrollment request. These plans may only be joined at certain times of the year: either during an individual's Initial Enrollment Period (IEP) when they first enroll in Medicare, or during the Annual Election Period (AEP), which runs from October 15 to December 7 of each year.
There are several types of Medicare Advantage Prescription Drug plans, from Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-For-Service (PFFS) plans. Each of these plans may have different requirements regarding how you can receive care. For example, HMO plans require doctor visits and other services to stay within its established network of health care professionals. Visiting an out-of-network provider may result in higher out-of-pocket costs.
Medicare Advantage Prescription Drug plan costs
Medicare Advantage Prescription Drug plans are sold through private insurance companies, meaning that the plan costs can vary. MAPD plans will generally charge a monthly premium, although some of these premiums can be as low as $0 a month. Beneficiaries must also pay for additional costs, such as copayments, coinsurance, and deductibles. When joining an MAPD plan, the beneficiary is still responsible for paying their Part B premium, because they are still enrolled in Original Medicare.
Medicare Advantage Prescription Drug plan costs and coverage details can change on an annual basis, so it is recommended that you compare plans in your area each year. You can use PlanPrescriber's free, no obligation Medicare Advantage plan comparison tool, which allows for a customized search based on whatever specific needs you might have.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.
Medicare has neither reviewed nor endorsed this information.
To learn about Medicare plans you may be eligible for, you can:
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