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How does an MAPD plan work?
A Medicare Advantage prescription drug plan (MAPD) combines medical, hospital and prescription drug coverage into one plan. It’s one of two options you have for Medicare prescription drug coverage. The other option is a stand-alone prescription drug plan (PDP).
What is a prescription drug plan (PDP)?
A PDP is a stand-alone prescription drug plan offered by private insurance companies. It’s used to cover prescription drugs and medications. You can pair a PDP with plans that lack drug coverage such as Original Medicare. PDPs cover certain drugs within a list called a drug formulary. The drugs in these formularies are usually separated out by cost in a drug tier list. There may be a late-enrollment penalty if you don’t enroll in a PDP during the correct enrollment period.
MAPD vs. PDP
MAPD plans and PDPs both offer prescription drug coverage, so what sets them apart? The key difference is what a PDP doesn’t cover. A PDP only covers prescription drugs. It’s meant to be paired with Original Medicare, which doesn’t offer drug coverage on its own. Meanwhile, MAPD plans offer all the coverage you get with Original Medicare bundled together with prescription drug coverage. MAPD plans and PDPs may also have different pharmacy networks to choose from.
Choosing the right plan
MAPD plans and PDPs can offer support for people in a wide variety of situations. MAPD plans can help lower Medicare costs and open the door to more kinds of benefits. You still pay the Medicare Part B premium with an MAPD plan, but your Medicare Advantage premium may be as low as $0. You may have different limits on the pharmacy you can use, though.
