What Are MAPD Plans in Medicare?

A MAPD plan is a Medicare Advantage plan that includes Medicare Part D prescription drug coverage. Medicare Advantage plans offer all the coverage of original Medicare (parts A and B), and often include additional services.

When a Medicare Advantage plan offers prescription drug coverage, it is known as a MAPD plan. MAPD plans can be a great option for people who want to have all their coverage bundled into one plan.

What types of MAPD plans are available?

You can find MAPD plans available in a few different plan types. The type of plan you select can affect your costs and the doctors you’re able to see. Not all plans are available in all areas, but common MAPD plan types include:

• Health Maintenance Organization (HMO) plans. Most MAPD plans are HMOs. When you have an HMO, you’ll be restricted to a healthcare provider network, and you’ll normally need a referral from your doctor to see a specialist.
• Preferred Provider Organization (PPO) plans. PPOs are another common type of MAPD plan. You’ll usually have a less restrictive network with a PPO, but your premium costs might be higher than with an HMO.
• Private Fee-for-Service (PFFS) plans. PFFS plans are a type of Medicare Advantage plan that allow you the ability to not have a set primary care physician or a set healthcare network.
• Special Needs Plans (SNPs). An SNP is a Medicare plan for people with certain medical conditions or financial situations. For example, there are SNPs open only to people with chronic heart disease. Others are only available for nursing home residents.

What companies offer MAPD plans?

You can find MAPD plans from several major insurance companies, including:

• Aetna
• Blue Cross Blue Shield
• Cigna
• Humana
• UnitedHealthcare

The type of MAPD plans available to you will depend on your area. Many plans are offered only in a certain state or region.

Medicare recipients are eligible to purchase Medicare Advantage plans, including MAPD plans, as long as they:

• are a U.S. citizen or U.S. national
• have Medicare Part A and Part B
• live in the service area of the plan desired

You can enroll in a Medicare MAPD at a few different times. Your first chance to select a MAPD plan is when you first enroll in Medicare.

You can enroll in Medicare starting 3 months before your 65th birthday. You have until 3 months after your birthday month to complete enrollment. You can select a MAPD plan during this first signup.

After your enrollment, you’ll have chances every year to enroll in a MAPD or change your current plan. The signup windows are:

• January 1 through March 31. You can use this period to switch from one MAPD plan to another. You can also switch from a Medicare Advantage plan without drug coverage to a MAPD plan. You can’t use this time to switch from original Medicare to a MAPD plan.
• April 1 through June 30. If you’re already enrolled in Medicare Part B, you can switch to an MAPD or any other Medicare Advantage plan during this window.
• October 15 through December 7. You can make changes to your existing coverage, including changing from original Medicare to a MAPD plan or switching from one MAPD to another during this time.

The cost of MADP plans depends on several factors, including:

• your ZIP code
• your state
• your coverage needs
• the plan you choose
• your income

Once you select a plan, there are several costs you might be responsible for. These include:

• Premiums. Most people don’t pay a premium for Medicare Part A. However, there is a premium for Part B. In 2021, the standard Medicare Part B premium amount is $148.50. Higher-income households might need to pay a higher premium. Medicare Advantage Plans have their own premiums. Some plans will not charge a premium on top of your Part B premium, but others will.
• Copays. A copay is the amount you pay for a service. Copays are normally due when you receive that service and are usually a set amount. For example, your plan might charge $15 per doctor’s visit. Copay amounts might be higher if you go out of your plan’s network.
• Coinsurance. Coinsurance works much like a copay, but the amount is a percentage instead of a flat fee. You’ll be responsible for a set percentage of the cost of services you receive. For example, you might need to pay 20 percent of the total cost of your healthcare service. The MAPD plan will pay the other 80 percent.
• Deductibles. Deductibles are the amount you need to pay before insurance will pick up the cost. For example, you might need to spend $500 toward services before your MAPD plan begins coverage. Some plans don’t have deductibles and others might have deductibles that exclude certain services.

Most plans have an out-of-pocket maximum per year. Your MAPD plan will cover 100 percent of the costs of your services if you hit this amount.

How do I find out how much MAPD plans cost in my area?

You can find plans in your area using the Medicare Plan Finder. The plan finder is interactive and will ask you for all the information it needs to find the best plan options for you. You’ll need to enter:

• The type of plan you’re interested in. You can select from Medicare Advantage plans, Medicare Part D plans, both Medicare Part D and Medigap plans, or Medigap plans. You’ll select Medicare Advantage plans to search for MAPD plans.
• Your ZIP code. Entering your ZIP code will pull up plans in your area.
• Your county or parish. After you enter your ZIP code, you’ll need to select your specific county or parish.
• Any help to pay for Medicare you receive. You can then select if you’re receiving Medicaid, Social Security Supplemental Income or assistance, or if you have a Medicare Savings Account. Select none if you are paying your Medicare costs out of pocket.
• Your current medications. You’ll need to enter all the medications you take and your current pharmacy in order to see drug prices for MAPD plans. Once you enter your medications and pharmacy information, you’ll see plans in your area. You’ll be able to click on the plans to see details, including the price you’ll pay for your current medications if you chose that MAPD plan.

MAPD plans are a type of Medicare Advantage plan that includes prescription drug coverage. You must have Medicare parts A and B, but will not need to choose Part D.

There are many MAPD plans available at a wide range of prices. Some are very affordable; however, you might pay less for your prescriptions if you get a separate Part D plan.

Your costs will depend on your area, income, and the coverage you need. You can shop around for the plan that best fits your needs.