Medicare Advantage Plans (Part C)

Medicare Advantage plans are “all in one” alternatives to Original Medicare. These “bundled” plans include Medicare Part A (Hospital), Medicare Part B (Medical), and usually Medicare Part D (Prescription Drugs). Some plans offer extra benefits like vision, hearing, and dental.

Medicare Advantage Plans have become very popular driven by their low sometimes $0 monthly premiums, low co-pays, prescription drug coverage, and extra benefits like dental, vision, hearing, hearing aides, over-the-counter stipends, free fitness programs and clubs like Silver Sneakers, and sometimes $0 copay virtual doctor visits. Benefits depend on the particular plan you choose.

While these plans have a lot of promise, there are many moving parts and it is important that you understand all of them. We make it easy for you to make the best decision and help you think through how to choose the best Medicare Advantage plan for you.

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.
  2. Does the plan cover your medications? You will want to check the plan’s prescription drug list to see if and how your drugs are covered. Different plans pay different amounts for the same drugs and plans can place restrictions on drugs through prior authorization, step therapy or quantity limits. You will also want to check to see if you can continue using your preferred pharmacy.
  3. What is the Plan’s Maximum-Out-Of-Pocket? The maximum-out-of-pocket (MOOP) is the most you will pay for in-network hospital or doctor services. This is a hard stop for plan approved doctor and hospital services each year.

You can change your Medicare Advantage plan every year without going through medical underwriting during the Annual Enrollment Period, which 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.

because some choices you make with these plans are irreversible. For example, if you leave your Medicare Supplement plan and try a Medicare Advantage plan for the first time, you have one year to try out the Medicare Advantage plan. During that year trial period, you can return to your Medicare Supplement without having to answer medical questions. After that time, if you moved from a Medicare Advantage plan to a Medicare Supplement, you would have to be medically underwritten to return to the Medicare Supplement and you could be denied.

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Medicare Advantage Trial Rights

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.

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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