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Medicare Advantage
Prescription Drug Plans

Medicare Advantage Prescription Drug Plans (MAPDs) can have a lot of options to choose from, which can be overwhelming. By reading through this information, you can begin to understand the important details you need to know.

It’s essential to understand that when you enroll in an MAPD plan, you will need to abide by the rules set by the insurance company. This means that your medical claims, including prescription claims, will no longer be processed by the federal government but by the private insurance company that offers the plan.

Enrolling in an MAPD plan replaces your Original Medicare benefits, including Parts A and B. However, you will still need to pay your Medicare Part B premium, and there may be a monthly premium for the MAPD plan as well. The amount of the premium will depend on the insurance carrier and the benefits provided by the plan.

How Do MAPD Plans Work?

Medicare Advantage Prescription Drug plans are administered by private insurance companies that are approved by the Medicare program. These companies are required to offer the same benefits as Medicare Parts A and B, as well as the most basic prescription drug coverage. However, most MAPD plans provide additional benefits beyond these minimum requirements.

In contrast to Original Medicare, MAPD plans have specific networks of providers and facilities that are contracted with the insurance carrier offering the plan. Claims are submitted directly to the insurance carrier, not the federal government.

Because MAPD plan members agree to pay a higher cost share of expenses, the rates for these plans are often lower than those for Medicare supplements.

Comparing Medicare Advantage Plans to Medicare Advantage Prescription Drug Plans

Unless a Medicare Advantage plan lists “Prescription” in the name, it does not include prescription drug coverage. If you enroll in a Medicare Advantage plan without prescription drug coverage, you’ll need to also enroll in a stand-alone Part D plan.

MAPD Costs

Medicare Advantage Prescription Drug plans (MAPDs) have varying healthcare costs, depending on the individual’s insurance provider, network, and coverage options. These costs usually include premiums, deductibles, copayments, and coinsurance. It is important to note that individuals are still required to pay the Part B premium, which amounts to $164.90 in 2023.

Medicare Advantage Prescription Drug Plan Benefits

As we’ve previously mentioned, Medicare Advantage Prescription Drug plans can offer additional benefits beyond prescription drug coverage. Dental, vision, and hearing services are often included in these plans. This may include coverage for dental exams, cleanings, and restorative treatment, as well as an annual eye exam and some payment towards eyeglasses or contact lenses. Hearing exams and hearing aids may also be covered.

Moreover, some MAPD plans provide an allowance for over-the-counter medications, such as vitamins and allergy medications. Certain plans may also offer transportation to and from doctor’s offices, meal delivery, and gym memberships. The Silver Sneakers program is one of the most popular fitness benefits included in these plans. Keep in mind that benefits can vary depending on the plan and the insurance carrier, so it is essential to review the details of each plan carefully.

Medicare Advantage Prescription Drug Plan Limitations & Disadvantages

As previously mentioned, Medicare Advantage plans must offer the same benefits as Original Medicare, including coverage for cancer treatment and dementia. However, hospice benefits are not included in Medicare Advantage plans.

Additionally, MAPD plans have a deductible and require copayments and coinsurance for services. There is also a separate deductible for prescription drug coverage. Beneficiaries should be aware of the high out-of-pocket maximum, which can reach around $5000 per year before the plan covers all costs at 100%.

Finding the Best Policy

A licensed agent can assist you in selecting the most suitable Medicare policy based on your health and lifestyle. By asking questions about your requirements, we can provide you with several plan options from multiple carriers. Once you make a decision, we can help you complete the enrollment process and handle all necessary paperwork. Our services don’t end there, as we will keep in touch during crucial enrollment periods to ensure you still have the best plan available.

Medicare Advantage Prescription Drug Plan Enrollment

Individuals who have already enrolled in Medicare Parts A and B can apply for a Medicare Advantage Prescription Drug plan except for those who have been diagnosed with End-Stage Renal Disease (ESRD). They can enroll during their Initial Enrollment Period or Annual Enrollment Period, while some individuals may qualify for a Special Enrollment Period. It is important to note that these plans are not available in all areas, and a licensed agent can help you determine which plans are available in your location.

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