Medicare Advantage Prescription Drug Plans

Medicare Advantage Prescription Drug Plans have numerous options, and it can be difficult to navigate through all your choices.

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After reviewing this information, you’ll have the knowledge to get begin your Medicare Advantage Prescription Drug (MAPD) journey.

The most important thing to know is that when you enroll in an MAPD, Medicare Advantage Prescription Drug Plan, you’re bound to the rules of the insurance carrier.

Your claims will no longer go through Medicare. Your coverage is from a private insurance company.

Medicare Advantage Prescription Drug Plans (MAPD)

Enrollment into a Medicare Advantage Prescriptions Drug Plan will replace your Medicare Part A and Part B. You still pay your Part B premium, and you might pay a premium for the MAPD plan.

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Costs can vary depending on the benefits and network of the MAPD.

How Do Medicare Advantage Prescription Drug Plans Work?

The Medicare beneficiary has coverage through a private insurance company that offers the Medicare Advantage prescription drug plan. For example, Aetna or UnitedHealthcare. The MAPD plan provides medical and prescription coverage, all in one policy.

The beneficiary has access to a list of providers that have a contract with the insurance company. The claims are submitted directly to the insurance company and process accordingly.

The Medicare Advantage Plan and Medicare Advantage Prescription Drug Plan premium rates are lower than a Medigap Plan because the Medicare beneficiary is agreeing to pay a higher cost share of expenses.

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The Provider Network Utilized is Typically One of the Following:

HMO – health maintenance organization. This type of plan tries to keep insureds healthy by offering a copayment for most minor doctor visits and the coverage is restricted to the HMO network of providers.

HMO POS – health maintenance organization with a point of service benefit. This is an HMO plan that offers some additional coverage when you are out of your typical service area.

When outside the HMO network, the beneficiary will incur a higher cost-share.

PPO – preferred provider organization. Providers in-network have agreed to negotiated rates. Medicare beneficiaries will have reduced cost share when using a provider in the network.

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The Center for Medicare and Medicaid Services provides a breakdown of what you need to know about the various types of Provider Networks.

What are the Differences Between Medicare Advantage Plans vs MAPD?

A Medicare Advantage Plan that does not specifically list prescription drugs in the name, will only provide medical coverage. To receive coverage for your prescriptions, enroll in an Advantage plan that includes prescription drug coverage.

Benefits of Medicare Advantage Prescription Drug Plans?

More About Advantage:

  • Most MAPD plans offer some type of dental benefit. Typically, they cover a couple of cleanings per year and bitewing x-rays.
  • Generally, a yearly eye exam is provided with an allotment toward the cost of prescription glasses.
  • An allotment toward over-the-counter medications such as vitamins and allergy medicines.
  • Transportation services to and from doctor visits.
  • Gym memberships that would encompass fitness classes and weight training. The most popular of these is the Silver Sneakers program.

What Coverage is Not Included in a Medicare Advantage Prescription Drug Plan?

Medicare Advantages Prescription Drug Plans and Medicare Advantage Plans must cover everything that is normally taken care of by Original Medicare. This includes cancer benefits and some treatments for dementia. The exception being Hospice benefits.

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How to Enroll in a Medicare Advantage Prescription Plan?

The MAPD or Medicare Advantage Prescription Drug plans are available for enrollment during certain enrollment periods; you must live within the service area. The first period is called the Initial Enrollment Period, then the Annual Election Period, and lastly is the Special Election Period.

What are the Disadvantages of MAPDs?

MAPDs always pass a deductible, coinsurance, and/or copayments on to the Medicare beneficiary. In addition, you should expect to have a high out-of-pocket maximum. Meaning the Medicare beneficiary may incur upwards of $5,000 in out-of-pocket expenses during any year that involves high utilization of the policy benefits.

How to Enroll in a Medicare Advantage Prescription Drug Plan

A Medicare beneficiary works with their licensed agent to review needs versus budget. Once you establish the options and factor costs, the Medicare beneficiary will decide what plan best meets their needs.

The process can be a little overwhelming but with a licensed agent to guide you, it can be a great and simple experience.

You can compare plans in your area to determine which one is the best option for you by either calling the number above or completing our rate form here.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.


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