MAPD
Medicare Advantage Prescription Drug Plans
Medicare Advantage Prescription Drug Plans (MAPDs) have many options, and it can be hard to sort through all your choices. As Medicare professionals, we’re here to share our knowledge and key information so you can begin your MAPD journey.
When you enroll in an MAPD, you’re subject to the rules of the insurance company. So instead of your claims going through Medicare, your coverage will come from a private carrier.
Are These Medicare Advantage Plans?
Yes, these are Medicare Advantage (Part C or “MA”) plans that include prescription drug coverage. An MA plan that doesn’t specifically mention “Prescription” in the name will just provide medical coverage.
What Does it Mean for You?
Joining an MAPD means it will replace your Medicare Parts A and B. You continue to pay your Part B premium, and you could pay a premium for the MAPD plan. Your costs may vary depending on the plan’s benefits and provider network.
Get the right coverage at the right price.
Speaking of the Network…
MAPD plans typically use one of the following provider networks:
- PPO – preferred provider organization
- HMO – health maintenance organization
- HMO POS – health maintenance organization with a point of service benefit
The Benefits of MAPD Plans
- Most plans offer a dental benefit (cleanings and bitewing x-rays)
- An annual eye exam is generally provided
- An allowance for over-the-counter medications (vitamins and allergy meds)
- Transportation to and from doctor appointments
- SilverSneakers fitness program
These plans must cover all services that are normally covered by Original Medicare, including cancer benefits and some treatments for dementia. The one exception is hospice benefits.
The Disadvantages of MAPD Plans
Beneficiaries can expect to have a high out-of-pocket maximum, which means you may owe up to $5,000 in out-of-pocket costs during a year that involves greater use of the policy benefits. In addition, you’ll be responsible for paying a deductible, coinsurance, and/or copayments for your Medicare Advantage prescription drug plan.
When to Enroll in MAPD Plans
Like all Medicare Advantage plans, MAPDs are available for enrollment during certain times of the year. To qualify, you must live within the plan’s service area and have Original Medicare.
The first period is your Initial Enrollment Period (when you first become eligible for Medicare), followed by the Annual Election Period (October 15 to December 7), and then the Special Enrollment Period (depends on certain circumstances).
How to Enroll in MAPD Plans
If you’re a Medicare beneficiary in Texas, work with your licensed agent to review your needs and budget. Oak Haven Insurance Agency can help you understand your options and factor costs, so you can choose the plan that best fits your needs.
The process can seem a bit overwhelming, but we’re here to make it simple. When you’re ready to compare plans in your area, give us a call or contact us online.
