How do Medicare Advantage Plans (MAPD) work?

If you join a Medicare Advantage Plan, you’ll still have Medicare. Still, you’ll get your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare, plus you’ll usually get Medicare drug coverage (Part D).

MAPD plans have provider networks, so finding a plan for where you live that gives you access to the providers you want to get services from is important. If you choose an HMO MAPD plan, no cost-sharing is available for services from providers outside the network. If you choose a POS or PPO plan, your costs may be higher if you get services out of network.

What’s covered by MAPD?

These plans must provide coverage for everything Original Medicare covers (but perhaps at a different cost-sharing and subject to seeing providers in the network), but they may also have coverage for things Original Medicare doesn’t cover, such as:

  • Fitness programs (gym memberships or discounts)
  • Vision, hearing, and dental services (like routine checkups or cleanings)
  • Transportation to doctor visits
  • Over-the-counter drugs
  • Services that promote your health and wellness.

Why are so many of these plans available for $0?

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. Sometimes, the company determines they don’t need additional premiums from you to provide those benefits.

Even with the $0 plans, all MAPD plans have an annual out-of-pocket limit. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover.

Other considerations

Each Medicare Advantage Plan can charge different out-of-pocket costs.

They can also have different rules for how you get services, like:

  • Whether you need a referral to see a specialist
  • If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care
  • These rules can change each year.

We do not offer every plan available in your area. Currently we represent 6 organizations that offer 46 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.