This article explains why clients enrolled in a Medicare Advantage Prescription Drug (MAPD) plan are still required to pay the Medicare Part B premium, and when exceptions may apply.
Key Terms
MAPD (Medicare Advantage Prescription Drug plan): A private insurance plan approved by Medicare that combines Medicare Part A (hospital coverage), Medicare Part B (medical coverage), and Medicare Part D (prescription drug coverage) into a single plan. MAPD plans do not replace Original Medicare enrollment.
Medicare Part B: The medical coverage portion of Original Medicare. Part B covers doctor visits, outpatient care, and other medical services. All Medicare Advantage members, including MAPD members, must remain enrolled in Medicare Part B to stay eligible for their plan.
Medicare Part B premium: The monthly amount a Medicare beneficiary pays to maintain their Part B coverage. The standard Medicare Part B premium is set annually by CMS. MAPD enrollment does not eliminate this premium unless a specific program or benefit reduces or covers it.
Part B giveback (Part B premium reduction): A benefit offered by some Medicare Advantage plans that uses rebate dollars to reduce the member's Medicare Part B premium on their behalf. Not all MAPD plans include this benefit.
Note: The Part B giveback reduces the amount deducted from their Social Security benefit (or their Part B bill). It is not issued as a separate payment.
Medicare Savings Program (MSP): A state-administered program that helps low-income Medicare beneficiaries pay for Medicare costs, including the Part B premium. MSP eligibility is separate from MAPD enrollment.
Medicaid: A joint federal and state program that provides health coverage to low-income individuals. For Medicare beneficiaries who are also enrolled in Medicaid (dual-eligible), Medicaid may pay the Medicare Part B premium.
Why do MAPD members still pay the Medicare Part B premium?
Enrolling in an MAPD plan does not replace Original Medicare enrollment. According to CMS, Medicare Advantage is a way to receive Medicare Part A and Part B coverage through a private plan approved by Medicare. The MAPD plan administers the benefits, but the member must still remain enrolled in both Medicare Part A and Medicare Part B to stay eligible for the plan.
Because the member remains enrolled in Medicare Part B, the Medicare Part B premium is still owed. The MAPD plan manages how Part A, Part B, and Part D benefits are delivered — it does not eliminate the government-required Part B premium.
What does an MAPD plan actually cover?
An MAPD plan combines the following Medicare coverage into a single private plan:
Medicare Part A — hospital and inpatient coverage
Medicare Part B — medical and outpatient coverage
Medicare Part D — prescription drug coverage
The MAPD plan is the vehicle through which these benefits are delivered. The member's underlying Medicare enrollment — including the Part B premium obligation — remains in place.
Example
A client may have a $0 monthly MAPD plan premium but still pay the standard Medicare Part B premium each month. These are two separate charges.
The $0 plan premium refers to the private insurance plan premium charged by the MAPD carrier. The Medicare Part B premium is a separate government-required payment that is not affected by the plan premium amount. A client with a $0 MAPD plan premium is not exempt from paying the Part B premium.
When does a client pay less — or nothing — for the Part B premium?
There are three situations in which a client may pay a reduced or $0 Part B premium:
Medicaid: If the client is enrolled in Medicaid, Medicaid may pay the Medicare Part B premium on their behalf. CMS confirms that states pay the Part B premium for many low-income beneficiaries through Medicaid.
Medicare Savings Program (MSP): If the client qualifies for a Medicare Savings Program, the state may pay part or all of the Part B premium.
Part B giveback benefit: Some MAPD plans offer a Part B premium reduction, also called a giveback benefit. CMS notes that Medicare Advantage plans may use rebate dollars to reduce the Part B premium on the member's behalf. If the client's specific MAPD plan includes this benefit, their Part B premium will be reduced by the giveback amount. Not all MAPD plans include a Part B giveback benefit.
Unless one of these three situations applies, the standard Medicare Part B premium is still owed each month.
Quick reference:
When a client asks why they still pay the Part B premium even though they have an MAPD plan, the answer is:
An MAPD plan is a private plan that manages Medicare benefits. The client must still stay enrolled in Medicare Part B to have the plan, which means the Part B premium is still required. The Part B premium is a government charge separate from the MAPD plan premium. The only way the Part B premium is reduced or eliminated is if Medicaid pays it, a Medicare Savings Program covers it, or the specific MAPD plan includes a Part B giveback benefit.
Additional Resources
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