Medicare indeed tends to involve some different prescription drug coverage types. Usually, figuring out the discrepancies between a PDP and MAPD leads to the most confusion.
Beneficiaries will have a formulary in both of the scenarios. This formulary is a list of all covered drugs. A beneficiary may request their insurance company to cover a certain drug that is unlisted in a few cases. An insurer will generally cover extra drugs necessary (from a medical point of view), but not others. In this particular scenario, a beneficiary can always locate a similar drug in terms of formula. They have to swap the one they were earlier prescribed, but they will likely require a new prescription.
What is a PDP?
A PDP stands for Prescription Drug Plan and is essentially a stand-alone Medicare plan (Part D). This plan covers various prescription drugs for those who buy it separately apart from their other Medicare coverage. People are qualified to enroll themselves for a PDP plan if they are eligible for Medicare advantages under Medicare Part B or Medicare Part A.
This insurance form helps in paying for several different prescription drugs, which includes:
- Vaccines
- Outpatient prescription drugs
- Biologicals
- A few of the medical supplies that Part B or Part A does not cover
What is an MAPD Plan?
An MAPD plan is essentially a Medicare Advantage plan that features prescription coverage. Private insurance organizations provide MAPD plans. These are generally more comprehensive and inclusive than Prescription drug plans and Original Medicare. The latter offers advantages like nurse hotlines, fitness programs, dental, vision or hearing coverage, etc.
MAPDs also entail HMOs (health maintenance organizations), PFFS (private fee for service) plans, PPO (preferred provider organizations) (PPOs), or MSA (Medicare Medical Savings Account) plans.
Selecting the Right Plan for Yourself
Contingent on your needs, selecting the right plan is of paramount importance. There are key differences that you might want to take into consideration. An MAPD plan has become greatly popular and prevalent over the last couple of years because such plans usually have a greater amount of comprehensive coverage, and some even include dental and vision. Also, an MAPD plan can provide coverage on more prescriptions compared to a PDP plan. What plan option between these two is ideal for you will rely heavily on your particular prescription requirements.
Generally speaking, those who can easily afford their health care and think that they do not require a lot of coverage might want to go with a PDP and Original Medicare. On the other hand, if you are looking for a greater amount of coverage, it is probably your best interest to select an MAPD plan.
If you have any questions regarding a PDP or MAPD plan or want to sign up for either one, please reach out to us!