Benefits of an MAPD plan vs. a PDP
Life has many milestones. You can drive at age 16, vote at age 18 and be eligible for Medicare at age 65. Embarking on this next milestone can come with a lot of information to sort through. We’re here to help break down some of the basics and the benefits.
First things first—what is Medicare?
Medicare is an insurance program backed by the U.S. government. There are certain times a person can enroll in the Medicare program and nearly all Americans who are eligible to enroll typically do. Depending on the situation, some people may get automatically enrolled while others need to apply. The first time you can enroll is called the Initial Coverage Election Period and it spans 7 months. Here’s how it breaks down:¹
- Begins 3 months before the month of your 65th birthday
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
You may incur a penalty and/or have a gap in coverage if you don’t enroll when you’re first eligible.
Medicare plans down to the letter
OK, now that you know what Medicare is, when you are eligible and enrollment details, let’s go over Medicare options and how to determine what may be the best choice for you. There are 2 main options of Medicare plans:²
- Original Medicare
- Medicare Advantage
These 2 main plans break down further into parts. Here’s what that looks like:³
• Medicare Part A (Original Medicare) – helps cover hospital stays, skilled nursing, home health and hospice care
• Medicare Part B (Original Medicare) – helps cover doctor visits, outpatient care, certain home healthcare services, durable medical equipment and preventive care
• Medicare Part C (Medicare Advantage) – covers Part A and Part B with additional coverage
• Medicare Part D – covers prescription drugs and divides into 2 plan option types: prescription drug plans (PDPs) and Medicare Advantage prescription drug (MAPD) plans
• Medicare Supplement – private insurance that covers gaps in Medicare coverage
What is an MAPD and PDP?
Now, let’s take a closer look at Medicare Part D, PDPs and MAPD plans. Medicare Part D can be divided into PDPs and MAPD plans.
What are MAPD plans?
MAPD plans are Medicare Advantage plans that include prescription coverage. MAPD plans are provided through private insurance companies and are more comprehensive than Original Medicare and PDPs. They provide benefits such as low copays with a mail-order pharmacy, fitness programs, nurse hotlines and more. Humana provides MAPD plans for those who are eligible. Review the different MAPD plans to see what works for you.
What are PDPs?
PDPs are stand-alone prescription drug (Part D) plans. So if you are eligible for Medicare Part A and/or Medicare Part B, you may be eligible to enroll in a PDP. What type of PDP you enroll in will depend on what prescriptions are covered.
It’s important to check the plan’s formulary, sometimes called Drug List (the list of drugs a plan covers).⁴
In 2020, PDP premiums and benefits may be changing. You can review the plan changes in your Annual Notice of Change booklet or online at Medicare plan documents. When choosing a PDP, keep in mind plan premiums, deductibles, copays and coinsurance when considering the total cost of PDPs. The Drug List changes per plan year. Check to see which drugs are covered under Humana plans.
Choosing the right plan for you
Choosing the right plan is important, depending on your needs. There are differences that you may want to consider. MAPD plans have become increasingly popular over the years because they tend to have more comprehensive coverage and some include vision and dental. MAPD plans can also offer coverage on more prescriptions than PDPs. Which plan option is best for you will depend on your prescription needs.⁵
If you’re already enrolled in a plan, note you can only make changes during the Annual Election Period, which takes place from Oct. 15 to Dec. 7 every year. During this time, you can make changes to your plan, such as switching to a Medicare Advantage plan or adding prescription drug coverage.
Humana has many different types of plans to choose from. Compare the different plans Humana offers to see what’s right for you.
- “Medicare,” USA.gov, last accessed September 3, 2019, https://www.usa.gov/medicare/.
- “Your Medicare Coverage Choices,” Medicare.gov, last accessed September 3, 2019, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices.
- “What Is Medicare Part A?,” HealthCare.com, last accessed September 3, 2019, https://medicareguide.com/medicare-part-a-34843.
- “PDP vs MAPD Plans,” SilverScript, last accessed September 3, 2019, https://www.aetnamedicare.com/en/compare-plans-enroll/part-d-prescription-drug-plans.html
- “Medicare Part D vs. Medicare Advantage Plans,” Medicare.net, last accessed September 3, 2019, https://medicare.net/medicare-part-d-vs-medicare-advantage-plans/.