Lewis & Ellis, LLC

MAPD Medicare

Health Care and Health Insurance
by Kim Shores
 Medicare Advantage prescription drug  are also known as MAPD plans.
Medicare Advantage prescription drug are also known as MAPD plans.

MAPD refers to "Medicare Advantage prescription drug," which is a type of Medicare Advantage plan that includes prescription drug coverage. MAPD plan can be a very affordable option. The specific costs of a policyholder's plan depend on your geographical area, income and the type of coverage you need. Here's everything you need to know about MAPD Medicare as a policyholder.


What MAPD Medicare is

As previously mentioned, MAPD is a particular kind of Medicare that is often used as an alternative to Original Medicare. It works well because it combines Medicare Part A and Part B in one. The most convenient part is that Part D coverage is also included in MAPD Medicare. In addition, prescription drugs are covered in the well-packaged plan. As the policyholder of an MAPD Medicare, you're covered for a variety of medical services, specific hospital stays and prescription drugs.

Who qualifies for MAPD?

It's important to note that you must first qualify for Original Medicare to be able to receive Medicare Advantage. Here are the requirements to get onto the next step:

  • An American citizen OR a permanent legal resident for five consecutive years.
  • 65 years old and above.
  • Eligible due to disability.


If you are interested in learning your personal qualification status, visit medicareadvantage.com.

Benefits of MAPD Medicare

So why should you go through the trouble of trying to find out if you are eligible for MAPD Medicare? What are the benefits? In fact, there are many advantages to this type of plan as compared to other plans under the Medicare packages.

First, MAPD offers a neatly bundled option to manage medical costs and coverage in the very same plan. This is far more streamlined than getting separate plans for each medical concern. In addition, MAPD plans are offered by private insurance companies so you do not have to go to another government plan. MAPD may also offer additional benefits for little or no cost.

Disadvantages of MAPD Medicare

This kind of option is not for everyone, and there are a few things to keep in mind as you go down this path. Because MAPD Medicare plans are offered by private insurance companies, there are different costs and coverage limitations. Speak with your representative to find out which plans you can get and which ones are best for your unique situation. This is not necessarily a drawback, but it is important to note that MAPD plans are not universally the same.

Drug plans

As previously mentioned, MAPD Medicare plans combine Part A, Part B and, perhaps most importantly, Part D. Let's take a look at what is included in each part, and why it is beneficial to the insured to have them all conveniently combined into one plan.

Medicare Part A

Medicare Part A essentially covers hospital insurance for those who need it. Here's a look at some of what is covered in Part A through Medicare:

  • Inpatient hospital care.
  • Inpatient mental health services.
  • Inpatient rehabilitation services.
  • Hospice care.
  • Limited home healthcare.
  • Limited stays in a skilled nursing facility.

Part A is extremely important for those who frequent hospitals due to their particular ailment. Hospital visits in America are notoriously expensive, and Medicare Part A helps relieve some of the financial stress associated with hospital stays.

Medicare Part B

Medicare Part B is the part of Medicare that provides medical insurance to the insured. Many people used it to cover different outpatient services that they need. Part A and Part B combined is what is known as Original Medicare. Part B covers a wide range of items as well as preventative care, some of which include:

  • Ambulance transportation.
  • Chemotherapy.
  • Medical equipment.
  • Emergency room care.
  • Kidney dialysis.
  • Laboratory testing.
  • Occupational therapy.
  • Outpatient hospital.
  • Bone density measurements.
  • Cancer screenings.
  • Mental health care.
  • Physical therapy.
  • Transplants.
  • Cardiovascular disease screenings.
  • Screenings for hepatitis B, hepatitis C, and HIV.
  • Vaccinations.

Medicare Part D

This part of Medicare is what makes MAPD Medicare so advantageous to those who have it. Part D plans cover formulary drugs that may not be covered in Parts A and B. Like other parts of Medicare, coverage and rates are dependent on the plan you choose and your insurance company. A person who is interested in getting a Medicare Part D plan must first qualify for the first parts of Medicare. Here are a few examples of what is covered by Medicare Part D:

  • HIV medications.
  • Antidepressants.
  • Cancer treatment medications.
  • Immunosuppressants.
  • Anticonvulsants.
  • Antipsychotics.

In addition, Medicare Part D also covers the majority of vaccines with no copay. The price of many prescriptions without insurance is mostly very high, and Part D can make a huge difference to those who have multiple medication needs. However, there are some prescriptions that are not covered by Medicare Part D. Some of these include:

  • Fertility drugs.
  • Medications used to treat eating disorders.
  • Medications for cosmetic purposes.
  • Medications are used to treat erectile dysfunction.

How to change coverage

According to Medicare.gov, changing coverage is relatively simple. However, the site urges people to consider the following factors before doing so:

  1. Cost.
  2. Which prescription drugs you need.
  3. Travel.
  4. Quality of care.
  5. Doctor and hospital choice.

Once you have decided to change coverage, just wait until your enrollment period begins and enroll in your plan of choice. Once you do this, you will be automatically un-enrolled in your previous Medicare plan. According to Medicare.com, "In some cases, joining a Medicare Advantage Plan might cause you to lose employer or union coverage. If you lose coverage for yourself, you may also lose coverage for your spouse and dependents." This is why it is important to have a discussion with your employer before making any changes.

VA drug coverage and Part D

If you are a veteran who is enrolled in VA drug coverage, you should know that you will be unable to enroll in Part D coverage. The two can not work at the same time. Medicare notes that  VA benefits will only pay at VA pharmacies and facilities. On the other hand, Part D will only work at the pharmacies that are available in your plan's network. For additional information, reach out to the Department of Veterans Affairs at 1-800-827-1000 or visit their website.

What types of MAPD plans are available?

There are different types of MAPD Medicare benefits available, depending on your specific requirements. Let's take a look at some of the different types of plans:

Health Maintenance Organization (HMO) plans

This is the most common type of MAPD plan. With an HMO plan, the insurer is restricted to a single healthcare provider network. In addition, those with the coverage usually need a referral from their doctor to see a specialist.

Preferred Provider Organization (PPO) plans

With a PPO plan, the insured normally receive more flexibility with a less restrictive network. In exchange for this, however, they may see premium costs that are higher than other plans. 

Private Fee-for-Service (PFFS) plans

For additional flexibility, a PFFS plan may be right for you. This plan allows you to not have a set primary healthcare provider or network.

Special Needs Plans (SNPs)

According to Medicare.com, "SNPs limit membership to people with specific diseases or characteristics." This option is perfect for those who need specific medical considerations including provider choices and drug formularies.

There are many benefits of MAPD Medicare, but be sure to discuss switching with your current insurer and employer.

Contact a Lewis & Ellis consultant today.

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