Difference Between Medicare Advantage and MAPD Plans

Medicare is the federally-run health care plan that many older adults subscribe to. It provides coverage to millions of U.S. adults, and that number is increasing every year. 

That’s why it’s one of the most lucrative types of insurance that independent insurance agents can sell today. At the same time, it can be a little confusing, as there are multiple parts and many different types of plans. 

To best serve your clients, it’s important to understand all these differences so you there are no questions as to what the plan will be providing. Below, we’ll dive into the difference between Medicare Advantage and MAPD plans. 

What is Medicare Advantage? 

Put simply, Medicare Advantage is a private insurance option for what’s known as Original Medicare. 

The latter is run completely by the federal government and is broken into two major parts. Part A covers hospital care, while Part B covers all other typical services, such as lab tests, outpatient services and doctor’s visits. 

Part C is better known as Medicare Advantage. While it’s similar in most ways to Original Medicare, there are some differences. 

For one, Original Medicare doesn’t require referrals. You just need to visit a medical provider who accepts Medicare. 

Medicare Advantage, by contrast, works like private insurance coverages do. They are managed plans that can either be HMOs — which are more restrictive, force you to choose a primary care physician and often require referrals — and PPOs.  

Original Medicare can come with higher out-of-pocket costs than Medicare Advantage, due to the way the pricing is negotiated. And with Original Medicare, you’ll be getting off-the-shelf plans, rather than hybrid plans that have been created by the private insurer. 

What are MAPD Plans? 

In order to get coverage for prescription drugs, people must purchase a separate plan that combines with Original Medicare. It’s called Medicare Part D, and it’s very important for most older adults, as prescription drug costs can be very expensive. 

In addition, those who are subscribing to Medicare plans are often more likely to require prescription drugs than younger adults. 

Technically speaking, Medicare Advantage doesn’t come with prescription drug coverage either. That being said, a significant portion of these plans do offer prescription drug plans, since they are so popular. 

These plans are referred to as Medicare Advantage Prescription Drug plans, or MAPDs. 

The benefit of these plans is that you don’t have to purchase a separate insurance plan just to get prescription drug coverage. It all gets wrapped into one insurance plan that, again, acts very similar to other private insurance plans that you might have subscribed to when you were working. 

What are the Other Benefits of MAPD Plans? 

Of course, if you subscribe to a Medicare Advantage plan, you could choose one that doesn’t offer prescription coverage and then just sign up for a Medicare Part D plan separately. However, that’s not in the best interest of most people. 

One of the main reasons is the simplicity that having one plan provides. You only have to pay one premium for all of your health insurance coverage, and you can get all the information you need about your plan in one place. 

More than this, though, MAPD plans offer a lot of great benefits that typically aren’t offered through Medicare Part D plans. This includes coverage for major services such as hearing, dental and vision — all areas of coverage that older adults typically need. 

MAPDs oftentimes also provide coverage for things such as nurse hotlines, gym memberships, transportation services, fitness and wellness programs, over-the-counter drugs and much more. 

These are services that usually aren’t covered by either Medicare Part D or Original Medicare plans, which is what makes MAPD plans so attractive. 

Educate Yourself on All Medicare Plans 

While there are many great benefits that MAPD plans provide, there may be scenarios in which a Medicare Advantage plan without prescription drug coverage would work best for some of your clients. 

This just speaks to how important it is to know your clients — what they need, what they want and what makes them “tick” — as well as know the inner workings of all Medicare plans. 

By becoming an expert in Medicare, you’ll be better prepared to serve your clients best. 

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At Good Life Insurance Associates, our experienced insurance sales associates are here to provide support and training for both new and experienced agents. To learn more about us, remember to explore our business support services. Or, to speak with a member of our team about your journey to becoming an independent agent, contact us today!  

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