MA and MAPD: What is the difference between a Medicare Advantage MA plan and a Medicare Advantage MAPD plan?

A Medicare Advantage plan is a health plan operated by a private insurance company.approved and regulated by the Centers for Medicare & Medicaid Services (CMS).  Sometimes, you will hear a Medicare Advantage plan called a "Medicare Part C plan" or a Medicare Health plan.

A Medicare Advantage MAPD (or MA-PD ) includes Medicare Part D prescription drug coverage and a Medicare Advantage MA plan does not include drug coverage.

Both MA and MAPD Medicare Advantage plans provide a combination of your Medicare Part A (in-patient or hospital coverage) and Medicare Part B (out-patient or physician coverage) and may also include other health-related and non-health-related "supplemental" benefits such as limited home healthcare, vision coverage, dental coverage, transportation, and recreational coverage (such as a "Silver Sneakers" membership). 


Important:  You may not be able to add Medicare Part D drug coverage to an MA.

If you join an MA plan (a Medicare Advantage plan without prescription drug coverage), you may not be allowed to also add a stand-alone Medicare Part D prescription drug plan (PDP).  If you want prescription drug coverage and want to join a Medicare Advantage plan, then you probably should choose an MAPD.  Only MSAs and PFFS Medicare Advantage plans can add stand-alone Medicare Part D drug coverage (see more below about MSAs and PFFS plans).  However, if you receive VA drug coverage, you can join an MA plan and use your creditable VA drug coverage or you can join an MAPD plan and use either your VA drug coverage or your MAPD drug coverage (but not both MAPD and VA drug coverage at the same time).

You can read more in our Frequently Asked Question:  "Can I enroll in an HMO and then add prescription drug coverage through a stand-alone Medicare Part D plan?" (Spoiler Alert: No)

You can also read more in our Frequently Asked Question:  "If I have VA drug benefits can I also add Medicare Part D prescription drug coverage?"  (Spoiler Alert: Yes)

A note on Medicare Advantage plans and Healthcare Networks

Most MAs and MAPD have healthcare networks and you may need to visit doctors (or other healthcare providers) who are part of the Medicare Advantage plan network - or be prepared to pay a higher coverage cost.


Types of Medicare Advantage Plans (MA and MAPD)

You can use our Medicare Advantage Plan Finder to browse through the Medicare Advantage plans.  As you review plan in your ZIP Code region, you might notice some common types of Medicare Advantage plans.

• HMO - Health Maintenance Organization plans
  
  HMOs are wellness-based Medicare Advantage plans and usually have the most-restrictive healthcare provider network, meaning that your healthcare costs may be considerably higher if you go outside of your plan’s established network. Also, depending on your HMO plan, you may only be allowed outside of your plan network with a referral from your doctor. Local HMOs are often very affordable compared to other Medicare Advantage plans because the restrictive network and focus on wellness helps to control healthcare costs. The majority of Medicare Advantage plans will be HMOs (Health Maintenance Organizations).
  
  
• HMO-POS - Health Maintenance Organizations Point-of-Service plans
  
  These Medicare Advantage HMO’s have a more flexible healthcare network allowing you to seek care outside of your plan’s network by paying a higher cost-sharing rate. This type of HMO is chosen often for people who travel part of the year, but still return home for the majority of their healthcare needs. For instance, you may have a $30 co-payment when you visit a healthcare provider in-network (at home) and pay $60 when you visit a provider outside of the plan’s network (while traveling).
  
  Important:
  (1) Sometimes an HMO POS plans will convert to HMOs (without the POS option) year-to-year - be sure to read any information you receive from your plan in your annual notice of change letter (ANOC). 
  (2) Depending on your HMO POS, you may find that out-of-network costs do not apply to your plan's that your Maximum Out-of-Pocket (MOOP) limit - check with your plan's Member Services for more details.
  
  
• PPO - Preferred Provider Organization plans
  
  Medicare Advantage PPOs have a less-restrictive provider network, but again, you probably will pay a higher cost-sharing rate when you visit a healthcare provider outside of your plan’s network.