Choosing Between PDP and MAPD

somarco

GA Medicare Expert
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Atlanta
What drug coverage do PDPs and MAPDs have in common?
Lower-cost prescriptions - A PDP and an MAPD both provide Medicare drug coverage for a certain group of out-patient prescription drugs where you should pay less for your prescriptions - and avoid the late-enrollment premium penalty should you ever wish to have drug coverage in the future.

Large list of covered drugs - Both Medicare drug plans have a formulary or drug list that shows what brand and generic prescriptions are covered by the plan (formularies will vary between plans and can have anywhere between 2,000 to 4,000+ drugs).

Large network of pharmacies - Both a Medicare PDP and an MAPD have a network of 50,000 to 60,000+ pharmacies where you can use the drug benefit.

Cost-sharing for drugs - Both drug plans have different cost-sharing for drugs on different levels or formulary "tiers" (for example, you may have a $30 copay for a Tier 3 brand-name drug, a $2 copay for a Tier 1 generic drug, and pay 25% of retail for a Tier 4 Specialty Drug)

Same rules and procedures - Both PDP and MAPDs plans are governed by similar rules and provide you with similar rights. You can also move from one type of plan to another without noticing much change in how your drug plan functions.



 
the Drug coverage on MAPD is far superior to that of a stand alone PDP

The only question is, How does MA fit the client verse Medsupp

But if it were based on drug coverage alone
MAPD wins every time
 
the Drug coverage on MAPD is far superior to that of a stand alone PDP

The only question is, How does MA fit the client verse Medsupp

But if it were based on drug coverage alone
MAPD wins every time
I’m anticipating that changes in 2025.

Look for PPOs to implement a Part D deductible, which levels the RX cost.
 
I’m anticipating that changes in 2025.

Look for PPOs to implement a Part D deductible, which levels the RX cost.
It'll be interesting. I've seen some PPOs w/ a Part D deductible - some are Tier 4+. Most of the time it's nominal - $200 or so, not the full $545.

I'll be shocked if it's either all tiers or even Tier 3+ or the full $595 or whatever it is for 2025 - I don't recall the exact figure...
 
When it come to health insurance, nothing is "always superior" to another, similar product.

I think the link provided in the thread starter is quite explicit about the subject matter. It is also informative.

I don't necessarily agree with all the points but it is a better summary than is often offered.
 
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