If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage plans. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries.
You might wonder why a beneficiary would choose to enroll in 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. Hospice care is covered by Original Medicare, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan. But, there can be some differences between Original Medicare and a Medicare Advantage plan. Those differences can be in how much you pay out of your own pocket when you receive health care. For example, you might have lower copayments and coinsurance or a smaller deductible.
Medicare Advantage offers at least the same coverage as Original Medicare, and may offer additional benefits. It may be one way of adding coverage for routine vision, or dental services, dentures, and more. Some Medicare Advantage plans have a $0 premium. However, regardless of how much you pay for a Medicare Advantage plan, you must continue pay your Medicare Part B premium[/alert]
There can also be differences in the coverage you receive. Some Medicare Advantage plans include routine vision, routine dental, and/or wellness programs. Many plans also include prescription drug coverage; those plans are called Medicare Advantage Prescription Drug plans (MAPD).
Do be aware that you would remain enrolled in Original Medicare even if you enroll into a Medicare Advantage plan, and you must continue paying your Medicare Part B premiums. However, if you enroll into a Medicare Advantage plan, you will not be allowed to obtain a Medicare Supplement insurance plan (Medigap).
It’s important to understand the differences between the types of Medicare Advantage plans to see which works best for you. There are several different types of Medicare Advantage plans:
Medicare Advantage plan eligibility is based on your eligibility for Original Medicare, Part A and Part B (except if you have ESRD). Generally, if you have Medicare Part A and Part B, you are eligible for Medicare Part C. However, you must live in the service area for the Medicare Advantage plan that you’re considering.
If you have other health insurance coverage, for example through an employer or union, ask your plan administrator about that plan’s rules before you enroll in a Medicare Advantage plan. In some cases, you may lose your other coverage if you enroll in the Medicare Advantage plan and you may be unable to get it back if you change your mind later.
You may only enroll in a Medicare Advantage plan during specified election periods:
Initial Coverage Election Period: You can enroll into 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 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in 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 3 months before your month of eligibility, during the month of eligibility, and 3 months after the month of eligibility. For example, if your Medicare Part A and Part B coverage begins 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 into a Medicare Advantage or Medicare Prescription Drug Plan or switch plans. If you’re already enrolled into a Medicare plan, you can use this period to disenroll from your plan.
Medicare Advantage Disenrollment Period: If, after enrolling in a Medicare Advantage plan, you change your mind, you can switch back to Original Medicare from January 1 through February 14 each year. If you would be losing prescription coverage as a result of the switch, you can also enroll into a stand-alone Medicare Part D Prescription Drug Plan during this time, if you wish.
Special Election Period: Generally, once you enroll into a Medicare Advantage plan, you stay enrolled in the plan until the next Annual Election Period (AEP) opens. However, there are some life events that might qualify you for a Special Election Period (SEP) during other times of the year, so you can make a change to your Medicare Advantage coverage. Some examples of these life events include (but aren’t limited to):
Check with the plan before you get a service to find out whether they will cover the service and what your costs may be. You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
If the plan decides to stop participating in Medicare, you‘ll have the right to join another Medicare Advantage Plan or return to Original Medicare.
Another option is a Medicare Supplement plan with has a larger monthly premium, but covers all your deductibles and coinsurance.