Medicare Advantage Plans

Medicare Part C, also known as Medicare Advantage plans, coordinate Original Medicare benefits and are offered by private insurance companies. If you currently have Medicare part A and B, you may choose to enroll in a Medicare Advantage plan.

What you need to know about Medicare Advantage

A Medicare Part C plan offers the same coverage as Medicare Part A and B and may also provide additional benefits such as vision and dental. Some Medicare Part C plans have a $0 premium. You must continue to pay your Medicare Part B premium no matter how much you pay for your Medicare Part C plan. Some plans may also include prescription drug coverage also known as Medicare Advantage Prescription Drug plans (MAPD).

You may not obtain a Medigap plan if you are enrolled in a Medicare Part C plan.

Types of Medicare Part C plans

There are many types of Medicare Part C plans and it behooves you to discover which plan is a better fit for your needs.

  • Medical Savings Account plan (MSA) – Includes a bank account and a high deductible. The funds you deposit into the account is tax-free under the condition you use it on IRS-qualified medical expenses. The amount you are required to deposit varies from plan to plan.
  • HMO (Health Maintenance Organization plan) – Allows you to see professionals and doctors under their provider network. If your doctor is part of the provider network, this may be a good option to avoid out-of-pocket expenses.
  • Special Needs Plans (SNP) – There are three different Special Needs Plans.
  1. To cover beneficiaries living in institutions
  2. Those with chronic conditions such as AIDS/HIV, diabetes or End Stage Renal Disease (ESRD).
  3. Dual eligible for Medicare and Medicaid

Prescription drug coverage is included in this plan

  • Private Fee-for-Service Plan (PFFS) – This plan determines how much you will pay for care and how much providers shall be paid. The plan will not cover services if the doctor does not agree to the terms of the plan. The doctor has to agree to treat you and accept the terms of the plan.
  • Health Maintenance Organization – Point of Service plan (HMO-POS) – Covers both out-of-network and in-network care with rates differing. When you find health care with in-network providers, you will pay less out-of-pocket.
  • Preferred Provider Organization plan (PPO) – This plan provides a high level of flexibility and allows you to choose and doctor that accepts Medicare assignment in both out-of-network and in network.

Eligibility for Medicare Part C

If you have Original Medicare and live in the service area for the Medicare Part C plan you are considering, then you are eligible for a Medicare Advantage plan, unless you have End Stage Renal Disease (ESRD).

Before you enroll in a Medicare Part C plan, ask the plan administrator about the plan’s rules before you enroll if you have other health insurance coverage (eg – through a union or employer).

Enrollment in Medicare Part C

You may enroll in a Medicare Part C plan during the following election periods:

  1. Special Election Period (SEP) – Typically, you enroll in a Medicare Part C plan and stay with the plan until the next AEP, Annual Election Period. If you you experience a qualifying life event, you are eligible for a Special Election Period and may make changes to your Medicare Part C coverage. The following are example life events which may include, but are not limited to:
    • Qualifying for the Extra Help program to help pay for prescription drugs
    • Moving into a nursing home or another qualifying institution
    • Moving outside your existing Medicare Part C plan’s service area
  2. Initial Coverage Election Period (ICEP) – You may enroll into an MAPD (Medicare Advantage Prescription Drug) plan or Medicare Part C plan when you become eligible for Original Medicare. Your Initial Coverage Election Period is a seven month window which begins three months before the month of your 65th birthday, the entire month of your birthday and three months after your 65th birthday. If you receive Social Security disability and you are below the age of 65, you may be able to get Medicare on the 25th month after you begin receiving Social Security disability and you may enroll in a Medicare Part C plan between the 22nd month and 28th month of receiving Social Security disability.
  3. Medicare Part C Open Enrollment Period (OEP) – January 1 – March 31st is an opportunity for you to switch back to Original Medicare if you have enrolled in a Medicare Part C plan and decide to change your mind. Bear in mind, you will be losing prescription drug coverage of you choose to switch so you may choose to enroll in a stand alone Medicare Part D plan at that time.
  4. Annual Election Period (AEP) – October 15 – December 7 is the Annual Election Period. During this time you may change, drop or add to your current coverage. You may choose to enroll into a Medicare Part C, Medicare Part D or switch to a different plan. The plan you choose to enroll into will begin on January 1 of the following year.