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What is the difference between a Medicare PDP and MAPD?

Category: General Medicare Part D (PDPs and MAPDs)
Updated: Jul, 04 2024

A "PDP" is the abbreviation used for a stand-alone Medicare Part D prescription drug plan.  A PDP provides coverage of your out-patient prescription drugs that are found on the Part D plan's formulary.

An "MAPD" is the abbreviation for a Medicare Advantage plan that offers prescription drug coverage.  An MAPD provides coverage for your out-patient Medicare Part D prescription drugs, and also includes coverage of your Medicare Part A (in-patient and hospital coverage) and Medicare Part B (out-patient and physician coverage).  An MAPD may also provide supplemental benefits beyond usual Medicare coverage such as vision care, dental care, health club memberships (like Silver Sneakers), transportation, and more.  In general, a Medicare Advantage plan (with or without Part D drug coverage) is also called a Medicare Part C plan.

Both a PDP and an MAPD provide Medicare Part D drug coverage.

If you need prescription drug coverage, and are eligible for Medicare Part A and/or Medicare Part B, you can enroll in a either a stand-alone Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan that provides drug coverage (MAPD), depending on whether you want drug only coverage or both health and drug coverage.

A note on Medicare drug coverage and Medigap policies

If you are enrolled in a Medicare Supplement or Medigap plan - you can only join a PDP for your Medicare Part D prescription drug coverage.  You cannot use a Medicare Advantage plan (MAPD or MA) together with your Medicare Supplement.  It is actually illegal for someone to sell you a Medigap policy if the salesperson knows that you are enrolled in a Medicare Advantage plan - unless your Medicare Advantage plan coverage ends before the effective date of the Medigap policy.

A note on Medicare drug coverage and VA, TRICARE, and Employer Drug Coverage

You may already be receiving prescription drug coverage through the VA or TRICARE - and since this coverage is considered "creditable" (meaning it is at least as good as basic Medicare Part D coverage), you do not need to join a Medicare Part D plan, but you can join a Medicare Part D plan (PDP or MAPD) and use either drug benefit depending on your purchase.  Keep in mind that you cannot use both coverages for a single purchase.

However, if you receive employer drug coverage that is considered "creditable" (ask your employer health plan administrator whether your drug plan is creditable), you probably cannot join a Medicare Part D plan and also keep your employer coverage.

In fact, if you join a Medicare Part D plan, you probably will lose all of your employer health plan coverage (not just drug coverage) - so ask your employer plan before enrolling in a PDP or MAPD.

:  How does a Medicare drug plan actually work?

In general, Medicare Part D prescription drug plans provide insurance coverage for your prescription drugs.  So like any insurance, you will pay a monthly premium (unless you join a plan with a $0 premium), pay an initial deductible (unless you join a plan with a $0 deductible), and receive some form of coverage for any drugs that are on your plans drug list or formulary.

Every Medicare Part D or Medicare Advantage plan is a little different, with different premiums, deductibles, drug coverage (plans do not cover the same drugs), and cost-sharing (what you pay for your drugs).

For more information, please see our popular Frequently Asked Question, "What is a Medicare Part D plan?" found at: Q1FAQ.com/563

Question:  Where can I see the PDPs or MAPDs in my area?

You can use our Medicare Part D Plan Finder to see all stand-alone Medicare Part plans in your state.  You can begin at PDP-Finder.com and then just choose your state.  You can then click on the plan name and see plan details.  We also have links to the plan's formulary or drug list.

You can see all Medicare Advantage plans in your county (or ZIP code area) using our Medicare Advantage Plan Finder.  You can begin at MA-Finder.com and then enter your ZIP and click on the green button to see plans in your area - or you can click on your state and then choose your county from the list and see Medicare Advantage plans in your area.  You can click on the plan name and see coverage details for the plan, the plan's contact information, and a link to the plan's formulary or drug list.

And for more information, please see our FAQ:

How will I choose between a stand-alone Medicare Part D prescription drug plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)?

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    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.