What is MAPD?

What is MAPD?

There are a lot of acronyms in Medicare, and even more in insurance. We know, it can get very confusing when you are not hip to the “Medicare/ insurance world” lingo. As a result, one of the most repeated acronym questions we hear is: What is MAPD?

Medicare MAPD plans are private insurance plans offered by Insurance Carriers to replace Original Medicare. Also called Medicare Part C, they offer a single payer option to beneficiaries. In addition, they offer extra benefits to members above and beyond what is covered in Medicare Part A and Part B. Finally, they also include a Part D drug plan.

What does MAPD Stand for?

MAPD Stands for: Medicare Advantage Prescription Drug.

If the plan does not offer drug coverage, then it is just called a MA (Medicare Advantage) Plan. As mentioned, these plans are also called Medicare Part C, and insurance companies offer Medicare MAPD plans with extra benefits to take the place of Original Medicare.

What Do Medicare Advantage Plans Cover?

Medicare Advantage Plans are regulated by the CMS (Centers for Medicare and Medicaid Services). This agency makes sure that every plan offers at least the same standards of care and coverage that Original Medicare offers. Most plans offer additional benefits, not covered by Original Medicare, such as vision, dental, hearing and even gym memberships such through organizations like SilverSneakers or Renew Active.

Medicare Advantage Plans are often set up as managed care plans with networks of doctors and hospitals members have access to. To learn more about how these networks work, please read, HMO vs PPO – Which is Better?

Costs of MAPD

Medicare Advantage Plans often come with lower premium costs than Supplement Plans. Some of them even offer “zero premium” options. They are not technically “free” because everyone still has to pay their Medicare Part B Premiums directly to the government each month.

However, they are low cost options because the government is paying the insurance company to take beneficiaries onto their books and off the government books. Essentially, the Medicare Advantage Insurance companies are replacing beneficiaries Original Medicare with their Part C plan and becoming a single-payer.

PDP vs MAPD

PDP is an acronym to Prescription Drug Plan. We also refer to it as Medicare Part D. You can read more about PDP Drug Plans here.

Similarities between PDP and MAPD Plans

• Just like Medicare Advantage (Part C), PDP plans are not administered by the U.S. government, but instead by private insurance companies. Just like MAPD Insurance plans, you can shop to find the best PDP plan for your needs each year.

• And also, just like Medicare Advantage Insurance plans, you do not have to go through medical underwriting to be accepted into a Part D plan.

• You can enter into a PDP (or MAPD) plan each year during AEP – the Annual Enrollment Period which runs from October 15th – December 7th.

Differences Between Medicare Advantage and Part D Plans

• First, if you have Original Medicare, you will need a PDP plan in addition to Parts A & B to cover your prescription drugs needs. They are not included.
• Additionally, beneficiaries on Original Medicare + a PDP Part D Drug Plan often also have a Medigap Plan (Supplement) to cover the 20% of costs, co-pays and co-insurances that Medicare does not cover.

• MAPD Healthcare Insurance Plans, on the other hand, include all three of these options in one (Parts A + B + D).
• As a result, you will not need a standalone PDP plan or a Medigap Plan in addition. All you need is your MAPD Plan (aka Medicare C).

Further Medicare Reading

HMO vs PPO Which is Better?

HMO vs PPO Which is Better? Insurance has changed a lot over the last 20 years, and there is no better example than the way we define and use provider ...
Read More

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab? How Long Does Medicare Pay for Rehab? It depends on what Medicare Plan you have. Medicare often pays for at least part of ...
Read More

Does Medicare Pay for Stem Cell Therapy?

Does Medicare Pay for Stem Cell Therapy? When does Medicare pay for stem cell therapy? The answer is: in a limited amount of cases. Stem cell therapy is still controversial ...
Read More

What is MAPD?

What is MAPD? There are a lot of acronyms in Medicare, and even more in insurance. We know, it can get very confusing when you are not hip to the ...
Read More

Attained Age vs Issue Age

Attained Age vs Issue Age Medicare Supplement Insurance Companies all price their plans differently. One of the biggest differences between plan prices is whether or not an insurance company uses ...
Read More

What is Medicare Plan G?

What is Medicare Plan G? When people talk about Medicare Plan G, they are referring to the Medicare Supplement Plan G. It can also be called a Medigap Plan G ...
Read More

What are Part B Excess Charges?

What are Part B Excess Charges? Medicare Part B Excess Charges are important to understand when you are deciding what Medigap Plan (Medicare Supplement) to get. Every once-in-a-while, we hear ...
Read More

How to Apply for Medicare

How to Apply for Medicare (An Ultimate Guide) With so many rules, regulations, exceptions and unique situations, Medicare enrollment can get confusing. We are here to make it simple and ...
Read More

How Much Does an MRI Cost?

How Much Does an MRI Cost? There is nothing worse than getting a hospital bill with an unexpected number on it. So, if your doctor says you need an MRI, ...
Read More

What is Medicare Plan F?

What is Medicare Plan F? You may have heard, but there have been changes with who can get what Medicare Supplement Plans (aka Medigap Plans) now. Plan F and Plan ...
Read More

Medicare Easy Pay

Medicare Easy Pay - What is it & How do I get it? Medicare Easy Pay is the automatic payment system set up by CMS to pay your Medicare Premiums ...
Read More

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones. The ...
Read More

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away? As a Medicare Health Insurance Agent I hear this question over and over: "Is Medicare Plan F Going Away?" The simple answer is, no, ...
Read More

Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers Does it sometimes seem like Medicare and Insurance companies are trying to make things as complicated as they possibly can? Just when you think you ...
Read More

What is Silver Sneakers?

What is Silver Sneakers? Maybe you just overhead your neighbor talking about his free gym membership, or maybe your doctor asked you if you are a SilverSneakers user. You might ...
Read More

What Medicare Part A Covers

What Medicare Part A Covers Here is what Medicare Part A Hospital Insurance covers: Inpatient Hospital CareSkilled Nursing CareStays at Skilled Nursing Facilities (short-term)Home Health CareHospice Care In addition: Part ...
Read More

What is the Medicare Donut Hole?

What is the Medicare Donut Hole? The Medicare Donut Hole (or Doughnut Hole) is a coverage gap in the Part D Prescription Drug Plan where beneficiaries could pay more for ...
Read More

2020 Part B Deductible

2020 Part B Deductible for Medicare The 2020 changes for Medicare were released this month. The 2020 Part B Deductible is just one of the increases you will see. The ...
Read More

Qualities of a Good Insurance Agent

The Top 6 Qualities of a Good Insurance Agent What are the qualities of a good insurance agent you should be looking for when you are searching for an agent? ...
Read More

Medicare Open Enrollment

Medicare Open Enrollment Medicare Open Enrollment runs from October 15th to December 7th. These are the same dates every year. What is Medicare Open Enrollment? Also called AEP - Annual ...
Read More

Railroad Medicare

Railroad Medicare - What You Need to Know Here is what you need to know about Railroad Medicare Benefits to be successful in your retirement planning. Introduction to Railroad Medicare ...
Read More

Does Medicare Cover Hearing Aids?

Does Medicare Cover Hearing Aids? One questions we hear a lot at Medicare Life Health is "Does Medicare Cover Hearing Aids? The simple answer is NO. However, some Medicare Advantage ...
Read More

Medicare and You 2020 & 2021

Medicare and You 2020 & 2021 Guidebook - Read This First Your Introduction to the Medicare and You 2020 & 2021 Book, and where to get a copy. The Medicare ...
Read More

Medicare Part A B C D

Medicare Parts A B C D Explained Medicare has four different parts: Medicare Part A B C D. Each of these parts serve a different function in our national health ...
Read More

Medicare For All Explained

Medicare For All Explained The Presidential Debates have started, and once again, the rising costs of health care is a hot topic. You will hear people (like Bernie Sanders and ...
Read More

5 Biggest Medicare Mistakes

The 5 Biggest Medicare Mistakes and How to Avoid Them No one wants to make a mistake that will cost them hundreds (or thousands) of dollars down the road if ...
Read More

How Much Does Medicare Cost?

How Much Does Medicare Cost? Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and ...
Read More

Using an Independent Medicare Insurance Agent

Should I Use an Independent Medicare Insurance Agent? When it comes to making decisions on and signing up for Medicare health care planning, you will have a few paths to ...
Read More

Medicare Penalties For Late Enrollment

What are the Medicare Penalties for Late Enrollment? There are two main Medicare penalties for late enrollment to be aware of when you are planning your health care in retirement ...
Read More

What is AEP?

What is AEP? Medicare's Annual Enrollment Period Do you love a good acronym? How about a very large amount of them? The health and insurance industries are nothing if not ...
Read More

Medicare Questions “FAQ’s”

The Most Frequently Asked Medicare Questions (FAQ's) & Answers Once you are familiar with the basics of Medicare, these are the Medicare questions we hear the most often that you ...
Read More

Part D Prescription Drug Plans

Medicare Part D Prescription Drug Plan Information Part D of Medicare covers Prescription Drugs. There are different Part D Prescription Drug Plans available. When you choose a plan you will ...
Read More

Medicare Advantage vs Medicare Supplement

Medicare Advantage vs Medicare Supplement (Medigap): What Medicare Plan is Best for Me? I am a firm believer that there is a good Medicare health plan out there for everyone ...
Read More

What is Medicare Advantage

What is Medicare Advantage? In this article, we look at what is Medicare Advantage (aka Medicare Part C). As we discussed in our Medicare 101 Post, there are two different ...
Read More

What are Medicare Supplements?

What are Medicare Supplements? What are Medicare Supplements? First, Medicare Supplements have many names: Medigap Policies, Med Sup, Medicare Supplement Insurance. However, they all refer to the optional insurance coverage ...
Read More

What is Medicare?

What is Medicare? Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance. The U.S. government started the ...
Read More

Carly H. Cummings

Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.