Glossary
MAPD vs Medigap
Two ways to structure Medicare coverage: a private Medicare Advantage plan, or Original Medicare plus a Medigap policy.
Two ways to structure Medicare coverage: a private Medicare Advantage plan, or Original Medicare plus a Medigap policy.
Medicare Advantage (including MAPD plans that add prescription coverage) is a private-plan alternative for receiving Medicare Part A and Part B benefits. A person remains enrolled in Medicare and must generally continue paying the Part B premium; a $0 plan premium is not the same as no cost. Networks, referral requirements, prior-authorization rules, cost sharing, and drug lists are plan-specific and can change annually. Medigap policies work alongside Original Medicare and cover certain Original Medicare cost sharing; a separate Part D plan is generally needed, and premiums are typically higher. Medigap availability, pricing, and underwriting depend on enrollment rights and state law — including guaranteed-issue rights and trial rights. Moving from Medicare Advantage to Medigap may involve medical underwriting unless such a right applies, so the timing of the initial decision matters. Medicare.gov, 1-800-MEDICARE, and your State Health Insurance Assistance Program are neutral sources.
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