How MAPD's Work

Medicare is confusing as it is. MAPD’s are meant to be an easy all in one solution. I believe that in Southern California, and in Los Angeles County, having a MAPD just makes sense. 

Let me explain why:

  • If you only have Original Medicare (Parts A & B) 80% of the approved amount will be covered by Uncle Sam, and you will have to pay the remaining 20%. There is NO LIMIT to your out-of-pocket costs each year. This can add up fast especially with rising health care costs.
  • If you have a Medigap plan, you will have to pay a monthly premium amount and you will still need to purchase a prescription drug plan. You also WILL NOT have any coverage for dental, vision or hearing unless you purchase a separate plan for those. Monthly bills for these can easily be $300+.
  • In addition, Medigap plans can and will increase the monthly premium amount, especially as you age.

MAPD's Control Cost


  • Many plans are $0 per month
  • Primary care visits and many prescription drugs have low or no co-pays
  • There is a cap to your yearly out-of-pocket expenses 
  • Remember you only pay when you go to the doctor or hospital with MAPD. If you have a Medigap plan, you pay per month regardless of whether you go or not.




Doctor Visits

Hospital Stays

Prescription Drugs




OTC Credits



Add’l Benefits

Cost per month


Avg. $100-$300


Ease Of Use

When you enroll in an MAPD, you will receive a card in the mail from the carrier. 

When you go to the doctor or hospital you just hand over this card to the person at the front desk. And that’s it. On the backend all the billing gets worked out. 


Example of MAPD Card

If there is any sort of copayment or coinsurance left for you to pay, then you will receive that bill in the mail. When you have an issue, you can contact the carrier directly and speak with member services, and their entire purpose is to assist members and find solutions to problems, concerns, and issues.

 That is essentially how a MAPD works. You enroll. You go to the doctor. You hand them your insurance card. They do all the back end billing work. You continue living life. If any questions or concerns, call member services for assistance. Or you can call us too.

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