Medicare Part C — Medicare Advantage PlansPrint
Overview of Medicare Part C
Medicare Advantage, or Medicare Part C, is a program that offers other health plan options that pay for original Medicare-covered services (Parts A and B) plus additional benefits and services through private health insurers such as:
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Private fee for service (PFFS) plans
- Special needs plans (SNPs)
How Medicare Advantage Plans Work
- The funds paid by the federal government to these private health insurers are used to pay the doctors, specialists and hospitals that you use; however, the care is managed by the private health insurers.
- The private health insurers may also offer supplemental benefits not covered by original Medicare such as vision, hearing, chiropractic care and more.
- Plan members usually are directed toward a network of doctors, hospitals and other health care professionals to receive services, but are not required to use those professionals.
Medicare Advantage Plans — Costs
- In a Medicare Advantage plan, you may pay a monthly premium as well as copayments - which are usually a fixed amount - when you receive services.
- The Medicare Advantage premium includes coverage for Medicare Part A and Medicare Part B benefits, prescription drug coverage (if offered) and any other benefits allowed by the plan.
- You will also continue to pay your Medicare Part B premium while enrolled in Medicare Advantage.
Medicare Advantage Plans — Drug Coverage
- Health insurers offering Medicare Advantage plans generally must provide at least one plan with basic prescription drug coverage, but most offer multiple options.
- If you choose a Medicare Advantage plan that offers prescription drug coverage, you must receive your benefits through that plan, rather than enrolling in a separate Medicare Part D plan.
Medicare Advantage Eligibility
- You are eligible for Medicare Advantage if you are entitled to Medicare Part A and enrolled in Medicare Part B.
- If you choose a Medicare Part C plan, your coverage becomes effective the same date as your Medicare coverage.
Medicare Part C Enrollment
There are four periods during which you may enroll in Medicare Part C:
Initial Enrollment Period
- This is a seven month enrollment period for those who are newly eligible for Medicare as a result of turning 65.
- The seven month period consists of the three months before, the month of and the three months after your 65th birthday.
- If you choose not to enroll during your initial enrollment period, you may be subject to a late enrollment penalty
Annual Enrollment Period
- Between October 15 and December 7 of each year, anyone eligible for Medicare Advantage coverage may either switch plans or enroll in a plan.
Open Enrollment Period
The open enrollment period from January 1 through March 31 of each year can be used only for certain Medicare Advantage enrollment situations. These situations are for:
- Medicare Advantage members who may enroll in:
- A different Medicare Advantage plan, or
- Original Medicare only
- Medicare Advantage plan with prescription drug members who may enroll in:
- A different Medicare Advantage plan with prescription drugs , or
- Original Medicare and a prescription drug plan
- Original Medicare* (Parts A and B) beneficiaries with no other coverage who may enroll in a Medicare Advantage plan
* Beneficiaries with original Medicare may also be enrolled in a Medicare plan.
Special Enrollment Period
- There are several special circumstances that would allow a Medicare-eligible recipient to enroll in a Medicare Advantage plan outside of the initial or annual enrollment periods.
- Some examples include, but are not limited to:
- Moving into the service area
- Involuntarily losing creditable coverage
- Becoming dual eligible (qualified to receive more than one state or federal subsidy)