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 Original Medicare doesn’t offer – like vision, hearing, and dental.

The most important things to consider when choosing a Medicare Advantage Plan is:

  1. Are your doctors in the plan’s network?
  2. Does the plan cover your medications?

It’s best to use network providers. You may pay more if you use providers outside of the network. Networks can and do change every year.

In the same way, prescription drug coverage from the Medicare Advantage plans can and do change every year. You will want to check: if all of your drugs will be covered, at what tier will 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 the same pharmacy.

Besides that, you can focus on the monthly premium, maximum out of pocket (MOOP), and any ancillary benefits like comprehensive dental, vision, hearing, fit bits, health club membership, etc. While some of the plans are $0, 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.

After you enroll during the annual enrollment period, you still have an opportunity to switch plans one time after the first of the year before March 31st. You can make a change to another Medicare Advantage Plan

You can also switch back to Original Medicare – a Medicare Supplement – but you may be required to pass medical underwriting for a Medicare Supplement. This can be a problem for someone whose health has deteriorated.

There are some situations where you can try a Medicare Advantage plan and still be guaranteed issue (you don’t have to go through medical underwriting) back into a Medicare Supplement.

The first situation is 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 must accept you and you can’t be charged more for any health conditions that you have.

The second situation is if you have a Medicare Supplement and then switch into a Medicare Advantage plan for the first. 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 at anytime 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 Adantage plan. In order to begin your Initial Coverage Election Period, you must have Medicare Parts A & B. A client can enroll in Medicare during their Initial Enrollment Period and simultaneously enroll in a Medicare Advantage plan using their Initial Coverage Election Period. Their Initial Coverage Election Period lasts seven months. If a Medicare beneficiary delays their Medicare Part B effective date until after they turn 65, their Initial Coverage Election Period will run three months before the month they elect Medicare Part B and three months after the month they elect Medicare Part B.

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. Medicare beneficiaries can change Medicare Advantage plans one time during this period or they can 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 this time, you can enroll or disenroll from a Medicare Advantage plan. Some examples are, losing your current health insurance coverage or moving.

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