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.

MAPD (Medicare Advantage Prescription Drug plan): A private insurance plan that combines Medicare Part A, Part B, and Part D coverage. MAPD plans do not replace Original Medicare enrollment.

Medicare Part B: The medical coverage portion of Original Medicare. 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. 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. Not all MAPD plans include this benefit. The Part B giveback reduces the amount deducted from the member's Social Security benefit — 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.

Medicaid: A joint federal and state program providing health coverage to low-income individuals. For dual-eligible beneficiaries, Medicaid may pay the Medicare Part B premium.

Enrolling in an MAPD plan does not replace Original Medicare enrollment. Medicare Advantage is a way to receive Medicare Part A and Part B coverage through a private plan — 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. Because the member remains enrolled in Medicare Part B, the Part B premium is still owed.

An MAPD plan combines Medicare Part A (hospital), Medicare Part B (medical), and Medicare Part D (prescription drug) coverage into a single private plan. The member's underlying Medicare enrollment — including the Part B premium obligation — remains in place.

A client may have a $0 monthly MAPD plan premium but still pay the standard Medicare Part B premium each month. 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. A client with a $0 MAPD plan premium is not exempt from paying the Part B premium.

There are three situations in which a client may pay a reduced or $0 Part B premium:

Unless one of these three situations applies, the standard Medicare Part B premium is still owed each month.

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