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?
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?
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.
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.