Medicare Advantage Plans or MAPD Plans

Medicare Advantage plans or MAPD plans are extremely popular among seniors. In fact, about 54% of all seniors choose the MAPD plans are their Medicare option.

What makes these plans so popular? Well, many things starting with usually are a no cost option or zero monthly premiums. The reason there are no premiums is that the government is saving money because these plans are from the insurance industry and they absorb all costs. The government pays the insurance companies to run these plans, but the payment is less than it would cost to have these seniors on just Original Medicare. It’s complicated but the plans save the government money.

In addition to no monthly premiums (there are a small number of plans that have a premium but not enough to worry about), the plans have many extras not found in Original Medicare.

1. No monthly premium

2. A fixed maximum out of pocket (Original Medicare does not have a maximum out of pocket).

3. Additional benefits like dental, vision, and hearing options

4. Gym membership or some equivalent

5. Some plans have allowances for meals or other items. Usually in special needs or dual needs plans. (Special needs means certain illnesses while dual eligibility means both Medicare and Medicaid enrollment)

6. Fixed copay for all medical services, unlike Original Medicare which charges 20% or sometimes 35% of the cost of the procedure.

7. Financial stability for the Medicare recipient who is on a fixed income, so known charges before having any procedure are welcomed by-product of these MAPD plans.

Of course, there are other options but those above are the most popular. The downside of these plans is you must stay within their network of doctors and hospitals. The hospitals are not an issue but sometimes the doctors can be. Ensure your broker looks up all your doctors and confirms they accept the specific plan you are considering joining. (Many doctors take some but not all the insurance carriers’ plans, so be careful.)

In summary, these MAPD plans are extremely attractive and offer more benefits than Original Medicare and many Medicare Supplement plans.

Choose wisely and do not allow any sales pressure to choose a specific plan because the broker or agent is recommending it. Just make sure your doctor takes the plan and and that local hospitals are included.

Recently, we got a new hospital in town and had to wait about 45 days before they had signed up with all the MAPD insurance carriers, so their hospital was in network.

The MAPD plans are all great with some offering a little more than others so pick carefully.

You can sign up for any plan during your initial Medicare enrollment period which is up to 60 days after your effective date. There are two periods annually where you can change plans. The first is the Annual Enrollment Period or AEP and you can choose as many different plans as possible. The last one being the one you get enrolled on. That AEP runs from October 15th through December 7th each year. Then you have the Open Enrollment Period which runs from January 1st through March 31st. During the OEP you can only change your MAPD plan once. You are then locked into that plan until December 31st.

These plans are well designed, and each insurance carrier enhances them annually to stay competitive. The advertising is highly competitive, and each carrier tries to outdo the other.

The rules of engagement between brokers and prospect is extremely strict and enforceable by CMS to maintain the integrity to protect seniors. Brokers are not allowed to call seniors unless you have a relationship. Meaning no cold calls. Seniors must call you. Even when you receive a referral from a client to one of their friends, that friend must call you first, you cannot call them.

We all know, people ignore rules and regulations and find around the rules.

I receive ten calls daily with one excuse or another as to why they are calling but they are merely call centers selling Medicare Advantage to the disadvantage of seniors. They do not care what plan you are on, they only want to change your plan, so they make a commission. CMS is aware but is not doing anything to stop these calls. But if an individual broker makes the

call, he can lose his license and all commissions if found guilty. Not complaining, merely stating the facts.

These plans are not for everyone so make sure the senior understands how these plans work and that they are not Medicare Supplements. That is a different kind of plan and has a monthly premium in addition to your Part B monthly premium. They also have separate times to buy the plans.

Lastly, you, as a senior, have 84 different options in Clark County. That is too many for anyone not in the insurance business to understand and grasp the differences between plans. Use a broke or agent as they cost you nothing. I will state that I prefer using an independent broker or agent and not one who works for the insurance company. The insurance company rep can only sell you their plans, so your options are limited.

I hope this information is useful and if anyone has questions, please contact me via phone or email and I will respond quickly.

Also, you may want to take a look at Medicare 2025 Information. 2026 Medicare Information coming soon.