Medicare Advantage Plans

Medicare Advantage Plans (also known as Part C) are an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Some plans may have lower out-of-pocket costs than original Medicare, depending on your healthcare needs. Some plans offer extra benefits that Medicare Part A & Medicare Part B don’t offer; like vision, hearing, and dental.

Things to Consider When Choosing a Medicare Advantage Plan:
  1. Are your preferred doctors and hospitals in the plan’s network? It’s best to use network providers. You may pay more if you use providers outside of the network. Medicare Advantage plan networks can and do change every year.
  2. Does the plan cover your medications? You will want to check the plan’s formulary for your drugs. Are your drugs covered, at what tier are they be covered, and do any of your drugs have any restrictions, like prior approval, step therapy or quantity limits? You will also want to check to see if you can continue using your preferred pharmacy.
  3. What does the plan cost? You should focus on the monthly premium, the maximum out of pocket (MOOP), and any ancillary benefits like comprehensive dental, vision, hearing, health club memberships, etc. While some of the plans have a $0 premium, you still must pay your Medicare Part B premium on a Medicare Advantage plan.

You can change your Medicare Advantage plan every year. The annual enrollment period runs from October 15th to December 7th. During that time, you can select another Medicare Advantage plan that will be effective January 1st of the following year.

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After you enroll during the annual enrollment period, you still have an opportunity to disenroll during the Medicare Advantage Disenrollment Period from the first of the year through February 14th.

You can switch back to Original Medicare – a Medicare Supplement and a Part D plan– but you may be required to pass medical underwriting for the Medicare Supplement. This can be a problem for someone with health issues.

There are some situations where you can try a Medicare Advantage plan and still be guaranteed issue for a Medicare Supplement if you switch back to Original Medicare.

Medicare Advantage Trial Rights

You have “Trial Rights” if you turn 65 and sign up for Medicare Parts A & B and a Medicare Advantage plan. You have one year to try that plan. If you drop out of that plan within a year, you are guaranteed issue into a Medicare Supplement. The Medicare Supplement insurance company must accept you and you can’t be charged more for any health conditions that you have.

The second Trial Rights situation is if you have a Medicare Supplement and then switch into a Medicare Advantage plan for the first time. In this situation, you have a year to try out the Medicare Advantage plan. During that year, you can switch back to your old Medicare Supplement plan without having to go through medical underwriting.

Enrollment Periods

Initial Coverage Election Period

Your Initial Coverage Election Period is the first time you can enroll in a Medicare Advantage plan. In order to begin your Initial Coverage Election Period, you must have Medicare Parts A & B. You can enroll in Medicare during your Initial Enrollment Period and simultaneously enroll in a Medicare Advantage plan using your Initial Coverage Election Period. Your Initial Coverage Election Period lasts seven months. If you delay your Medicare Part B effective date until after you turn 65, your Initial Coverage Election Period will run three months before the month you elect Medicare Part B and three months after the month you elect Medicare Part B.

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Annual Enrollment Period

This period runs from October 15th to December 7th every year, and you can choose a Medicare Advantage plan for the following year. You can also disenroll from a Medicare Advantage or Medicare Part D plan during this time.

Medicare Advantage Open Enrollment Period

This runs from January 1st to March 31st. You can change Medicare Advantage plans one time during this period. You can also disenroll from Medicare Advantage and enroll in a Medicare Supplement and Medicare Part D plan. To enroll in a Medicare Supplement after you have had a Medicare Advantage plan, you may have to pass medical underwriting and you could be turned down for coverage.

Special Enrollment Period

A few Life Events can make you eligible for a Special Enrollment Period. During a Special Enrollment Period, you can enroll or dis-enroll from a Medicare Advantage plan. Qualified Life Events include losing your current health insurance coverage and changing your legal residence.

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