MAPD Plans vs. PDPs: The Differences You Should Know

Are you new to selling Medicare? Are you opening yourself to selling different types of plans? Well, Medicare involves a few different types of prescription drug coverage. Often, the most confusion comes in determining the differences between MAPD and PDPs.

In both cases, the beneficiary will have a formulary. The formulary is a list of all drugs that will be covered. In some cases, beneficiaries can ask their insurer to cover a drug that is not listed. Insurers will typically cover additional drugs that are medically necessary, but not others. In that case,  beneficiaries can almost always find a similar drug on their formulary to replace the one they were prescribed but they’ll probably need a new prescription.

What Is A PDP?

A PDP, or Prescription Drug Plan, is also commonly referred to as Medicare Part D. It covers prescription drugs for beneficiaries who purchase it as a separate plan in addition to their other Medicare coverage. Those who have already enrolled in Original Medicare (Parts A and B) can also choose to enroll in a Part D plan.

What Is MAPD?

An MAPD plan is considered Part C – it’s basically Medicare Parts A and B plus D. It’s an option for beneficiaries who have a bit more to spend on their premiums to gain prescription drug coverage. MAPD plans are offered by private insurers who contract with Medicare. In addition to prescription drug coverage, MAPDs offer other service coverage, like dental and vision.

What’s Best For The Client?

This all depends on the consumer. One Medicare Advantage plan is usually the better choice over an Original Medicare plan with a Prescription Drug plan as it offers more coverage for one rate. However, if a beneficiary needs more financial help, they’ll need a Medicare Supplement plan. Med Supp plans won’t include prescription drug coverage, but they’ll help to cover copayments and coinsurance along with other out-of-pocket costs. Therefore, clients who are in more of a financial bind may opt for Original Medicare with a Medicare Supplement plan and a Part D plan (three plans in total), while those who can afford a Medicare Advantage plan would fare well with an MAPD (one plan). Clients who can afford their health care and feel that they do not need much coverage may choose to stick with Original Medicare and a PDP.

The more clients you speak with and the more plans you sell, the clearer this will become. You’ll learn to better serve your clients with plans that best suit their needs. If you’re looking for training services and help with your marketing efforts and lead generation, SMA may be the FMO for you. Get started by speaking with one of our advisors today at 1-844-452-5020.