What is an MAPD Plan?

Medicare Advantage is considered as an alternative to Original Medicare. It covers everything that Original Medicare does, helping policyholders pay for additional services excluded from Original Medicare’s coverage. 

And, while not every Medicare Advantage plan includes prescription drug coverage, many plans do. These are known as MAPD plans.

What does MAPD stand for?

MAPD stands for Medicare Advantage Prescription Drug plan. This includes all of Medicare’s features and it doesn’t require you to get separate Part D coverage.

How do I sign up for an MAPD plan?

Ways you can enroll:

  • Join during your Initial Enrollment Period. This lasts from three months before the month of your 65th birthday to the three months after that month, but keep in mind you have to be enrolled in Original Medicare first.
  • Get it during the Annual Enrollment Period (if you have Original Medicare). This begins on October 15 and ends December 7, with coverage effective on January 1 of the following year.
  • If you have a Medicare Advantage plan, you can switch to one with drug coverage during Annual Enrollment, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31.

What are the different MAPD plans?

MAPD plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and Special Needs Plans (SNP).

These plans will cover you within a network consisting of healthcare providers in your area. If you go outside the network, your policy may not cover you, though some policies are more lenient than others.

HMO plans allow you to choose your primary care physician, who will refer you to specialists. You need to stay within your coverage network, as out-of-network physicians can refuse to treat you in non-emergency situations.

PPO plans have more flexibility. You don’t need to choose a physician, nor do you need a referral to see a specialist. You can get out-of-network coverage but at a higher price. Your greatest discounts will be for your plan’s preferred providers. These are healthcare professionals within your network with whom you can get the best coverage with.

Like PPO plans, PFFS plans do not require choosing a primary care physician to get referrals from. You can get coverage out-of-network at a higher price. What makes this unique is that your costs are determined ahead of time. You pay the same amount for your Medicare-covered services so you can be prepared when it’s time to pay.

Lastly, SNPs are similar to HMOs in terms of requirements for choosing a physician and getting referrals. Out-of-network coverage is possible, but not the case for every plan. It’s geared toward individuals with financial issues, as well as those with chronic and disabling conditions.

Do you need an MAPD plan? We can help

At Turning 65 Solutions, we’re here to find you the plan you need so you can get the coverage you deserve. If you’re in need of an MAPD plan and would like to learn more, call us today at 830-217-6711.

Turning 65 Solutions can help you plan for the future.