Medicare Advantage Plans Medicare Part C
If you currently are enrolled in Original Medicare, Part A, and Part B, you can enroll in Medicare Part C, most commonly known as Medicare Advantage Plans. Private health insurance carriers offer Medicare Advantage plans, and they coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries.
You may wonder why a beneficiary would choose a Medicare Advantage plan. A Medicare Advantage plan is required to cover everything that Original Medicare covers (except for hospice care), including emergency and urgent care. Original Medicare covers hospice care, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan. There can be some differences between Original Medicare and Medicare Advantage plans. Those differences can be in how much you pay out of your pocket when you receive health care. An example would be, you might have
Medicare Advantage Plans offers at least the same coverage as Original Medicare and may provide some additional benefits. It can be one way of adding coverage for vision, or dental services, dentures, and more. Some Medicare Advantage plans have a $0 premium. Regardless of how much you pay for a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
There can also be differences in the coverages you receive. Some Medicare Advantage plans include vision, dental, and wellness programs. Some plans include prescription drug coverage; those plans are called Medicare Advantage Prescription Drug plans (MAPD).
If you decide to enroll in a Medicare Advantage plan, you will not be allowed to obtain a Medicare Supplement insurance (Medigap).
Types of Medicare Advantage (Part C) plans
It's important to know the differences between the types of Medicare Advantage plans to see which works best for your needs. There are many types of Medicare Advantage plans:
- HMO (Health Maintenance Organization plan): Lets you see doctors and other health professionals who participate in its provider network. If your doctor is already in the network, it can be a good option because you will pay less out-of-pocket when your doctor is in the network of the carrier.
- PPO (Preferred Provider Organization plan): Covers both in- and out-of-network providers, giving you the freedom to choose any doctor that accepts Medicare if you prefer that kind of flexibility.
- PFFS (Private Fee-for-Service plan): This plan type determines how much it will pay providers and how much you must pay when you receive care. The doctor you want to see has to accept the insurance carriers payment terms and agree to treat you. If the doctor doesn't agree to those terms, then the PFFS plan will not cover services through that doctor.
- SNP (Special Needs Plans): Are especially for people who have particular special needs. SNP plans cover Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions such as diabetes, End Stage Renal Disease (ESRD), or HIV/AIDS. These plans always include prescription drug coverage.
- HMO-POS (Health Maintenance Organization – Point of Service plan): Covers both in- and out-of-network health services, but at different rates. You will pay less out-of-pocket financially when you visit in-network doctors, labs, hospitals, and other healthcare providers.
- MSA (Medical Savings Account plan): Includes both a high deductible and a bank account to help you pay that deductible. The deposited amount varies from plan to plan. The money is tax-free as long as you use it on qualified medical expenses as designated by the IRS, which does include the health plan's deductible.
Eligibility for Medicare Advantage plans
Medicare Advantage plan eligibility is based on eligibility for Original Medicare, Part A and Part B (except if you have ESRD). If you have Medicare Part A and Part B, you can enroll in Medicare Part C. However; you will need to live in the service area for the Medicare Advantage plan that you're enrolling in.
If you have other health insurance coverage, for example through an employer or union, ask the administrator of your plan about that plan's rules before you enroll in a Medicare Advantage plan. In many cases, you may lose your other coverage if you enroll in the Medicare Advantage plan and you may be unable to get back in your employers' coverage if you change your mind later.
Enrollment in Medicare Advantage plans
You may only enroll in a Medicare Advantage plan during specified election periods:
Initial Coverage Election Period: You can enroll in a Medicare Advantage plan or Medicare Advantage Prescription Drug plan when you first become eligible for Medicare. Your Initial Coverage Election Period (ICEP), is a seven-month period that starts three months before the month you turn 65, includes the month you turn 65 and ends three months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you will qualify for Medicare on the 25th month after you begin receiving your Social Security benefits. If you fall into this category, you may enroll into a Medicare Advantage plan three months before your month of eligibility, during the month of eligibility, and three months after the month of eligibility. For example, if your Medicare Part A and Part B coverage begin in May, your Medicare Advantage plan ICEP is February through August.
Annual Election Period: The Annual Election Period (AEP) is October 15 through December 7 every year. The plan coverage you choose during the AEP begins on January 1 of the next year. It allows Medicare beneficiaries to add, change, or drop their current coverage. You can use this period to enroll in a Medicare Advantage or Medicare Prescription Drug Plan or switch plans. If you're enrolled in a Medicare supplement plan, you can use this period to disenroll from your plan.
Medicare Advantage Disenrollment Period: After enrolling in a Medicare Advantage plan, if you change your mind, you can switch back to Original Medicare from January 1 through February 14 each year. If you are losing prescription coverage as a result of the switch, you can also enroll in a stand-alone Medicare Part D Prescription Drug Plan during this time, if you wish.
Special Election Period: Generally, once you enroll in a Medicare Advantage plan, you stay enrolled in the plan until the next Annual Election Period (AEP) opens. However, some life events might qualify you for a Special Election Period (SEP) during other times of the year so that you can make a change to your Medicare Advantage coverage. Examples of these life events include (but aren't limited to):
- Moving outside the Medicare Advantage plan's service area
- Qualifying for Extra Help (a program to help you pay for prescription drugs)
- Moving into an institution (such as a nursing home)
Find out why many Medicare beneficiaries opt for a Medicare Advantage plan. To see if this route may be a good idea for you, contact Indiana Insurance Alliance agents at 765-462-6002 or website www.INinsureALL.com. We have the knowledge to answer your Medicare Advantage plan questions.
Contact: IndianaInsurance Alliance