MAPD vs. PDP Through Part D

When choosing Medicare prescription drug coverage, beneficiaries often have questions about the differences between MAPD vs. PDP plans through Part D. Ultimately, they want to know which type of plan will better fit their needs. If this applies to you, we’re here to help!

What is the Difference Between MAPD vs. PDP?

The number of acronyms Medicare involves often takes beneficiaries by surprise. When choosing prescription drug coverage, this is especially true. With Medicare Advantage, beneficiaries receive the coverage that Original Medicare provides, plus prescription drug coverage through a Medicare Advantage Prescription Drug Plan (MAPD), as well as other benefits, bundled into one policy.

Once you enroll in an Advantage plan, a private insurance company handles your claims instead of Medicare. In other words, it pays instead of Original Medicare.

In contrast, Prescription Drug Plans (PDP) are stand-alone plans that only provide prescription drug coverage through Part D of Medicare. You can purchase a PDP if you enroll in Original Medicare, with or without Medigap.

By law, each PDP must offer standard benefits in accordance with Medicare, covering certain drugs under its formulary. However, like Advantage plans, Part D prescription drug plans vary by location and provider.

Individuals who enroll in PDPs are responsible for specific costs depending on their prescriptions and plan. In addition, both MAPD and Part D PDP come with a coverage gap.

Pros and Cons of Medicare Advantage Prescription Drug Plans vs. Part D

First, let’s explore the perks of Medicare Advantage Prescription Drug Plans. First, MAPD coverage comes with extra benefits under your Advantage plan. Another benefit of enrolling in MAPDs is a lower premium through the Advantage plan – or no premium at all in addition to what you pay each month for Part B.

The disadvantage to MAPDs is that you’ll have to deal with the downsides of a Medicare Advantage plan. These include a limited network of providers, potentially high out-of-pocket costs, and a lack of coverage while traveling.

PDP coverage through Part D also comes with its own advantages. First, you can have Medigap coverage, whereas you cannot add a Medicare Supplement plan when you have an Advantage plan. Another benefit to enrolling in PDP is that you’ll keep Original Medicare, which allows you to see any practitioner accepting Medicare assignment. One of the disadvantages of a PDP through Part D is the higher monthly premiums you’ll pay for drug coverage when compared to the MAPD coverage you would get with an Advantage plan.

Is It Better to Have MAPD or PDP Coverage?

There’s no right or wrong answer. With several plans to choose from, the answer for you depends on your health and budget needs.

As you shop around, ask yourself these questions:

Do I plan on traveling within the next year?
Can I still afford my current plan?
Have my medical needs changed?
Did I have any issues with my current plan in the last year?
Are my medications still listed on my plan’s formulary?

Those who travel often may not wish to be subject to the restrictions of Medicare Advantage practitioner networks.

Each drug plan has a list of prescription drugs it covers known as a formulary. Each policy creates its own formulary and can make changes every year. Before you purchase prescription drug coverage, double-check to make sure the formulary includes your medications and dosages.

Once you find plans that cover your medications, compare costs and other benefits. Similar to provider networks, most plans have contracts with specific pharmacies. You’ll want to make sure your plan includes your pharmacy.

FAQs

Can you have a PDP and an MAPD?

You cannot have both a prescription drug plan through Part D and an MAPD at the same time. This is because you won’t need both; your MAPD is your drug coverage through Advantage, which almost all plans include. You may, however, add Part D coverage to your Advantage plan if it is a Private Fee for Service (PFFS)or Medical Savings Account plan without drug coverage.

Is a PDP a Medicare Advantage plan?

The short answer is no. Prescription Drug Plans are commonly known as Medicare Part D; Medicare Advantage plans include Medicare Advantage Prescription Drug plans (MAPD). PDPs are sold through private insurance companies, like Advantage plans.

Does the donut hole apply to MAPD plans?

Yes, MAPD involves the same type of donut hole as PDP plans. This means your MAPD will come with limitations on what prescription drugs it will cover.

Do MAPD costs count toward my Advantage plan’s maximum out-of-pocket?

Your drug costs using your MAPD don’t count toward your Advantage plan’s maximum out-of-pocket amount. However, the donut hole applies.

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How to Choose Between a MAPD and a PDP Through Part D

When it comes to prescription drug coverage, everyone’s needs are different. What's best for one person may be best for another. We recommend exploring all your options, before selecting a policy.

We can help! Call the number above or fill out our online form to compare rates.