What is Medicare Advantage (Part C)?

What are the pros and cons of a Part C Medicare Advantage plan?

Pros of Medicare Advantage Plans

With Medicare Advantage plans, you can get personalized, coordinated medical care at a lower cost, depending on your plan. There are many advantages of enrolling in a Medicare Advantage plan. You can get:

• All of your coverage bundled together in 1 convenient plan.
• Costs that may be lower than Original Medicare.
• Extra benefits such as coverage for vision, hearing, dental, wellness programs, and discounts on health-related items.
• Prescription drug coverage (if it’s included as part of the plan).
• All the rights and protections offered through the Medicare program.
• Help paying for premiums (subsidies), if you qualify.
• All the benefits of Medicare Part A and Part B plans, without buying supplemental insurance.

Cons of Medicare Advantage Plans

The following are some disadvantages of Medicare Advantage plans:

• If you select an HMO Medicare Advantage plan, you may have a small selection of providers to choose from. If you see a provider out-of-network, it can cost you more. However, other plan options will offer a wider provider network.
• With certain plans, you may see additional costs for things like drug deductibles and specialist visit copays.
• If you travel a lot, your plan may not cover services outside your service area.

What types of Medicare Advantage plans are available?

There are various kinds of Medicare Advantage plans, such as HMO, PPO, and Private Fee-for-Service plans. HMOs and PPOs each have certain characteristics, whether they are part of a Medicare plan or part of a regular health plan.

For example, an HMO plan typically comes with lower costs but requires you to see providers within a network and get referrals before you see a specialist. A PPO plan typically costs more, but offers more flexible options for seeing providers and may not require any referrals to see specialists.

What does a Medicare Advantage plan cost?

Depending on your Medicare Advantage plan, the costs you pay out-of-pocket can vary:

• You may pay a deductible, a certain amount you must meet before your plan begins to pay.
• There may be copays for doctor visits—this is a flat fee usually due at the time of the visit.
• You may have to pay a share for lab services and medical equipment.
• You will pay a monthly plan premium if there is one.
• You will continue to pay the Original Medicare Part B monthly premium, as well.
• Additional coinsurance or copays if you see providers outside your plan network.

To help control your costs, make sure you understand the terms of your plan and the out-of-pocket costs you may be required to pay.

How do I choose a Medicare Advantage plan?

It’s important to compare the benefits between your current coverage and the different types of Medicare Advantage plans (Part C). Be sure that you understand the additional benefits and any benefits (or freedoms) that you may lose.

You may want to consider:

• If you can change your current doctors
• If your medications are covered under the plan’s drug list formulary (if prescription drug coverage is provided)
• The monthly premium
• The cost of coverage. This could include annual deductible, copays, and coinsurance.
• What additional services are offered (i.e. preventive care, vision, dental, health club membership)
• Any treatments you need that aren’t covered by the plan

How do I enroll in a Medicare Advantage plan?

If you want to enroll in a Medicare Advantage plan, you must:

• Be eligible for Medicare
• Be enrolled in both Medicare Part A and Medicare Part B (you can check this by referring to your red, white, and blue Medicare card)
• Live within the plan’s service area (which is based on the county you live in–not your state of residence)
• Not have end-stage renal disease (ESRD)

Want more information about enrollment? Visit Medicare Part C Eligibility and Enrollment Information

Can I change my Medicare Advantage plan?

There are a few times during the year that you may be eligible to change your Medicare Advantage (MA) plan:

Annual Enrollment Periods

The Medicare Annual Enrollment Period (AEP) occurs every year from October 15-December 7. Anyone who is eligible for Medicare can change plans during this time. You can make as many changes to your plan as you'd like before December 7, and your new coverage begins January 1.

Medicare Advantage Open Enrollment occurs every year from January 1-March 31. This period is for Medicare Advantage customers only and is your opportunity to:

• Switch to another Medicare Advantage plan that better fits your needs, with or without drug coverage
• Switch to Original Medicare Part A and Part B, and add a standalone Part D prescription drug plan if you'd like one. Learn more about Original Medicare

You can only make one change to your Medicare Advantage plan during this period. Your new coverage will begin the first of the month after you make the switch.

Special Enrollment Periods

If you need to change your MA plan outside of the standard enrollment periods described above, you may be eligible for a Special Enrollment Period (SEP) for these qualifying events:

• Moving outside your plan's coverage area
• New Medicare or Part D plans are available due to a move to a new permanent location
• Recently released from prison
• Your plan is not renewing its contract with the Centers for Medicare & Medicaid Services (CMS) or will stop offering benefits in your area at the end of the year

CMS may also establish SEPs for certain "exceptional conditions" such as:

• If you make an MA enrollment request into or out of an employer-sponsored MA plan
• If you want to disenroll from an MA plan in order to enroll in the Program of All-inclusive Care for the Elderly (PACE).
• If you dropped a Medicare Supplement (Medigap) insurance plan when you enrolled for the first time in an MA plan and you're still in the federally mandated "trial period" 12 months after the purchase of your MA plan
• If you enrolled in a Special Needs Plan (SNP) but are no longer eligible
• If you were a non-U.S. citizen and have become "lawfully present" as a "qualified non-citizen" without a waiting period in the United States

To confirm if you're eligible for a SEP, contact us.