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MAPD vs. PDP Through Medicare Part D

Prescription drug coverage is not available under Original Medicare. This implies that in order to receive benefits, you must enroll in a separate medication plan. You have a number of alternatives when selecting your coverage to meet your financial needs and satisfy your medical requirements. A Medicare Part D plan or a Medicare Advantage Prescription medication Plan (MAPD) are the two most common options for Medicare prescription medication coverage.

In order to assist you decide which choice could be the best for you, we will explain why having a MAPD or Medicare Part D plan is necessary when you have Medicare.

A Medicare Advantage Prescription Drug Plan: What Is It?

Medicare Part A, which covers inpatient care, and Part B, which provides outpatient treatments, make up Original Medicare. Medicare Part C (Medicare Advantage) and Part plans are provided by private insurance firms to assist with the cost of prescription medications.

Prescription drug coverage-inclusive Medicare Advantage plans are frequently referred to as MAPD plans. MAPD plans combine Original Medicare benefits with extras like dental, vision, and hearing coverage that Medicare may not generally provide. However, MAPD plans could also come with limitations including high out-of-pocket expenses and constrained network options.

Understanding the benefits of your plan is crucial to ensuring that the coverage you choose best suits your needs in terms of cost and healthcare.

What distinguishes Medicare Part D Plans from MAPD?

Your insurance company instead of Medicare handles your claims when you sign up for MAPD coverage. As a result, Original Medicare is no longer your primary insurance.

Contrarily, Medicare Part D prescription drug plans (PDP) are independent plans that solely offer coverage for prescription medications under Medicare Part D. Therefore, even if you acquire a Medicare Part D plan, Original Medicare will still process your claims.

Each Medicare Part D Prescription Drug Plan is required by law to provide the same benefits as Medicare and to cover specific medications listed on its formulary. Medicare Part D Prescription Drug plans, however, differ by geography and provider, just like MAPD coverage.

Who Qualifies for Part D vs. MAPD?

You can receive MAPD or Medicare Part D if you are eligible for Original Medicare. You can sign up for either insurance if you:

  • Have U.S. citizenship
  • Medicare Parts A and B are present
  • Living in the desired plan’s service area

When you first become eligible for Original Medicare, you have two options: maintain Original Medicare and enroll in a Medicare Part D Prescription Drug coverage, or switch to a Medicare Advantage plan with a MAPD benefit. You cannot, however, do both.

When can I sign up for Medicare Part D or a MAPD?

When you sign up for Original Medicare for the first time, you have the opportunity to purchase prescription medication coverage. The month before, and the three months after your 65th birthday are the only times you can enroll in prescription coverage before the start date of Original Medicare.

You can alter your coverage once a year following your first Medicare enrollment.

Initial Coverage Election Period – From April 1 to June 30, you can enroll in a MAPD or a Medicare Part D PDP if you enroll in Medicare Part B during the General Enrollment Period (January 1 to March 31). When you sign up during this time, your coverage starts on the first of the next month.

Medicare Advantage Open Enrollment Period – Only those with Medicare Advantage plans are eligible to enroll during the Medicare Advantage Open Enrollment Period. You are allowed to make one modification each year between January 1 and March 31 if you are dissatisfied with your MAPD benefits or any other features of your Medicare Advantage plan. You can enroll in a Medicare Part D PDP after dropping a Medicare Advantage plan. Your modification then becomes effective on the first day of the subsequent month.


Annual Enrollment Period – Every year, from October 15 and December 7, you can sign up for the first time for a Medicare Part D or MAPD plan, or you can evaluate the changes to your existing plan and make adjustments for the upcoming year.

How Much Are Part D Plans Versus MAPD?

You must be aware of your out-of-pocket expenses for prescription pharmaceuticals before enrolling in a MAPD or Medicare Part D plan. Depending on the package you choose, you can be in charge of

  • A regular monthly fee
  • Coinsurance
  • Deductibles
  • Copayments


The majority of plans also include an annual maximum out-of-pocket amount. Therefore, your MAPD plan will pay 100% of your remaining expenses once you reach this benchmark amount.