Lauren Lewthwaite Last Updated On: August 20, 2024

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Here’s Everything You Need to Know About MAPD Plans

Health insurance is a no-brainer. If you’re approaching 65, those blissful golden years, your health insurance will soon come from Medicare. Fortunately, Medicare is relatively straightforward once you understand what each component means—Parts A, B, C, & D.

Part C or Medicare Advantage Plans are offered through private health insurance. Certain Medicare Advantage Plans may even cover prescription medication (Plan D), called MAPD Plans.

Read on, and we’ll help you determine whether MAPD Plans are something you should consider.

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Medicare Components Explained

Before we delve into the different Medicare offerings, reviewing Medicare’s components may be helpful.

Part A: Part A covers inpatient hospital care or treatment. It also covers the following:

Hospitalization
Nursing home or home health visits
Hospice

Part B: Part B covers outpatient care, such as seeing your primary care provider. This plan also covers the following:

Doctor visits
Ambulance
X-rays
Outpatient services like certain surgeries and therapies

Part C: Part C, or “Medicare Advantage”, is private insurance that bundles Part A, Part B, and sometimes Part D. Medicare Advantage plans may include:

Prescription medicine
Health and wellness services
Dental, vision, or hearing services

Part D: Part D covers prescription medication and is offered by private insurance. The different plans offer:

Drug tier costs
Different formulary (drug list) offerings
Costs for generic vs. brand medications

Now that we’ve gone through each component of Medicare, we can dive into MAPD plans specifically. Keep reading for that and more.

What Are MAPD Plans?

Medicare Advantage Prescription Drugs (MAPD) plans are great all-in-one health insurance. What makes MAPD plans attractive to policyholders is that they simplify things; you only have one policy.

When buying a Medicare Plan, you have the option between:

Original Medicare: Part A and Part B bundled together, or,
Medicare Advantage (Part C): Part A, Part B, and Part D—most Part C’s have prescription coverage.

Moreover, the federal government runs Original Medicare plans, which do not cover prescription drug coverage, so if you want Part D, you’ll have to turn to private insurance. On the other hand, if you have Original Medicare, you can simplify things and take out a Medicare Advantage Plan that bundles everything.

Medicare Eligibility

Medicare policies aren’t for everyone. If you’re looking into your health insurance options, here’s what makes you eligible for Medicare:

A US citizen or national
Seniors about to turn 65, from three months before and three months after their 65th birthday
If you live in a qualifying service area
If you have a disability, End-Stage Renal Disease, or ALS (also called Lou Gehrig’s disease)

If you’re not eligible, you’ll need to find health insurance separately until you do qualify.

Enrolling in MAPD Plans

If you’re eligible to enroll in a Medicare Advantage Plan and successfully enroll within the six-month window around your 65th birthday, you’re not locked into that plan. You can make changes to your health insurance plan during these open enrollment windows:

January 1 – March 31: If you’re unhappy with your current health insurance plan, you can switch from Original to Medicare Advantage or from a non-Part D policy to one that offers prescription drug coverage.
April 1 – June 1: As long as you’re enrolled in a Part B policy, you can transfer to an MAPD or Medicare Advantage plan.
October 15 – December 7: You can adjust or take out an MAPD Plan during this enrollment window.

Be sure that you enroll in Medicare on time if you are eligible, because delays can cost you hefty fines. Tip: Medicare and healthcare are an important part of retirement planning. After all, you want to be sure you have the coverage you need during your golden years. But there’s more to consider than just healthcare, which is why we put together this free retirement planning guide, so you can cover all the bases before relaxing into retirement. We’ve got you covered.

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How Much Are MAPD Plans?

If you’re living on a tight pension, you’ll want to ensure that the Medicare Advantage plan you choose fits within your budget. Regardless, before you take out an MAPD policy, it’s useful to have a general idea of how much it will cost you so that you can budget for it accordingly.

MAPD’s cost varies depending on your personal profile:

Where you live
Your home state
Your coverage requirements
The MAPD plan you select
Your income

For a rough estimate, in 2023, the average monthly premium for an MAPD plan was only $17.60.

However, keep in mind that just like other health insurance products, Medicare costs aren’t limited to just premiums. You’ll also pay for deductibles, copays, and coinsurance. Here’s a breakdown of Medicare Advantage’s additional costs:

Deductibles: Every insurance product has a deductible; in other words, the policyholder pays for their health care treatments until the deductible amount (it varies) is satisfied. Once the deductible is paid, then copays and coinsurance kick in. It’s also important to note that many MAPD policies have two deductibles for general health care and prescription medication, while some plans have $0 deductibles across the board.
- In 2023, prescription drug coverage deductible can be at most $505 a year.
Coinsurance: Once you’ve met your Part B deductible, coinsurance charges 20% for most covered services.
Copayment: Copayments are set dollar amounts you pay for a product, like a prescription or a health care service. Medicare Advantage has a cap, or “maximum out of pocket (MOOP)” limit for the year, which was $8,300 for 2023.
Prescription Drug Coverage “Donut Hole”: Certain MAPD policies have a coverage gap, which means once you reach a certain limit (in 2023, it was $4,660 for prescription medication), you’ll pay a larger amount until you hit $7,400. If you reach the top-end limit, you’ll only have to pay small copays or coinsurance for the rest of the year.

Making sure you understand your out-of-pocket costs is key to budgeting for your healthcare needs.

Finding Out Medicare Advantage Costs for Your Area

Finding out how much MAPD policies cost in your area is painless using Medicare’s “Plan Finder” tool. All you’ll need to do is key in a few pieces of information, and presto: you’ll find out how much Medicare will cost you!

Before you get started, ensure you have these items with you:

Plan Type: Select the policy you’re interested in, such as Medicare Advantage (MAPD), Part D, Medigap, or Medigap & Part D.
ZIP Code & County/Parish: Type in your zip code and select your county/parish.
Assistance: Indicate whether you receive financial aid from Medicaid or Social Security Supplemental Income. Also, select if you have a Medicare Savings Account or plan to pay for your plan outright.
Current Medications: If you’re on any medications, you must input them and your pharmacy to view MAPD plan drug costs. You can then see the plans and their cost for your area.

You can also get access to free MAPD quotes to find out what you can expect to pay.

Once you’ve got an idea of costs, you can better decide if a plan is right for you. You have options when it comes to MAPD plans; keep reading for those.

Your MAPD Policy Options

There is a Medicare Advantage plan suitable for every person and every budget. The key is taking the time to explore your MAPD options. Here are some MAPD policies available to you:

Health Maintenance Organization (HMO): Medicare Advantage plans are often HMOs. These plans use a healthcare provider network and health services out of the network aren’t covered except in emergencies. You’ll also need a referral to see a specialist.
Preferred Provider Organization (PPO): PPOs have higher premiums because they are more lenient with provider networks and will cover health care costs for outside network treatment.
Private Fee-for-Service (PFFS): These plans are the most flexible as you don’t need a primary care provider or a healthcare network.
Special Needs Plans (SNPs): SNPs are for individuals with chronic health conditions, policyholders in a nursing home, or those with low income.

Everyone wants the best coverage possible, but unfortunately budget does play a part in your choice. By carefully reviewing each policy type and cost, you can find an option that fits your needs and that doesn’t break the bank.

Medicare Advantage Insurance Providers

If you’re considering buying a Part C policy through private insurance, you’ll be pleased to know that many major providers offer MAPD plans. Here are some of the private insurance providers offering MAPD plans:

Aetna
Amerigroup
Anthem Blue Cross & Blue Shield
Cigna
Humana
UnitedHealthcare

Having a choice of carriers helps you choose the best option for you.

Who Should Consider MAPD Plans?

There is no such thing as a “universal” fit; finding the right health insurance plan is a matter of matching your healthcare needs with the right Medicare Advantage policy. Here are a few more tips on who should buy a Medicare Advantage policy:

Original Medicare is helpful, but if you require prescription medication, you must either take out a Part D or grab a Medicare Advantage policy.
If you want a plan that delivers not just medical services but health and wellness services, MAPD plans may be right for you. Medicare Advantage plans may include “extras” like gym memberships, alternative therapies, vision and dental, transportation services, or meal delivery.
If you’re 65, you qualify for Medicare.

Medicare Advantage plans are a sound choice if you want all-in-one health insurance that you can alter annually during enrollment windows. If this sounds like you, a MAPD plan might be just the ticket for your healthcare needs.

Final Thoughts on MAPD Plans

If the time has come to take out a Medicare health insurance plan, you have choices. You can elect to stick with Original Medicare, or you can go with private insurance and bundle everything, along with a few extras depending on the policy you pick, for Medicare Advantage.

MAPD policies are something everyone should consider, especially if you require prescription medication. But, if you don’t need prescription drugs, Original Medicare may be more than enough.

The best way to determine whether MAPD policies are right for you is to use the Medicare Advantage tool available on the Medicare Advantage website and explore your options—both in coverage and cost.

The only way to find the best insurance coverage (this goes for any insurance product) is to shop around. The right insurance won’t fall into your lap without you doing some leg work first! Let us help you explore your Medicare Advantage options with access to free health quotes here, so you can get started finding the perfect health insurance for you.

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Lauren Lewthwaite Lauren Lewthwaite has been freelance writing for almost five years writing content that ranges from health to insurance and everything in between. Lauren is also a trained translator in French and English and is a dog-mom to an adorable Australian Shepherd.