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Medicare Advantage Plans

Consider these facts in deciding if a Medicare Advantage Plan for hospital and medical coverage is right for you:


Medicare Facts


Medicare Advantage Resources

What is Medicare Advantage?

We've put this section together to help answer some of your questions, but feel free to contact us with your questions.

Medicare Advantage Plans (also known as Medicare Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include Medicare Part D prescription drug coverage or you can enroll in a separate Medicare Part D prescription drug coverage plan. Medicare Advantage Plans include:

No health questions are asked (except the existence of End Stage Renal Disease or to qualify for certain Special Needs Plans). Acceptance is guaranteed for all Medicare eligibles every year during the appropriate enrollment period regardless of health conditions (except End Stage Renal Disease). Dual Eligibles -- people on both Medicare and Medicaid -- can enroll year-round. Most Medicare Advantage plans require you to pay a co-pay each time you see a doctor, receive medical treatment, or visit a hospital. The maximum out-of-pocket expenses you are required to pay are often capped on a per-year basis, but not always.

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most cases there are extra benefits and lower co-payments than in the Original Medicare Plan. However, with PPO and HMO plans you may have to see doctors that belong to the plan or go to certain hospitals to get services or risk higher out-of-pocket expenses for going "out-of-network". PPFS plans enable you to see any health care provider that accepts Medicare assignment as well as the terms and conditions of the PFFS Plan.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. Depending on where you live, some Medicare Advantage Plans have a $0 premium plan option, and some even reimburse you for part of your Medicare Part B premium. Some plans include dental and vision benefits in addition to coverage for hospital stays, doctor visits, diagnostic tests, inpatient and outpatient services, skilled nursing, and more. Some plans even include free health club memberships.

If you join a Medicare Advantage Plan, your Medigap (also known as a Medicare Supplement) policy won't work. This means it won't pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan.

from Medicare.gov, Medicare Advantage Plans (2017)


Original Medicare vs. Medicare Advantage

Medicare covers many of your health care needs. Today’s Medicare is working with private companies' health plans to provide different ways to get your health care coverage in the Medicare program. The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare health plan choices include:

from Medicare.gov, Medicare Options Compare (2017) & Medicare.gov, Medicare Plan Choices Overview (2017)


Enrollment Periods

How do I get more information and enroll?

Enrolling in a Medicare Advantage Plan is easy. To speak with a licensed insurance agent call or click here for a free Medicare Advantage quote and consultation. We can answer your questions and handle your enrollment entirely over the phone. If you prefer, we can mail, fax, email or personally deliver an application to you.

What is the Initial Coverage Election Period?

The Initial Coverage Election Period ICEP (not to be confused with the Initial Enrollment Period IEP for Medicare Part D) is a one-time event when an individual first has the opportunity to enroll in a Medicare Advantage (MA) plan. It occurs for most people when turning age 65 and enrolling in Medicare Parts A & B for the first time. This period begins three months before an individual is first eligible for both Medicare Part A and Part B, and ends on the later of:

  1. the last day of the month before the individual is eligible for Parts A and B, or;
  2. the last day of the individual's Part B initial enrollment period.
    The initial enrollment period for Part B is the seven month period that begins 3 months before the month an individual meets the eligibility requirements for Part B, and ends 3 months after the month of eligibility.

The Initial Coverage Election Period for a Medicare Advantage (MA) enrollment election will frequently relate to either the individual's 65th birthday or the 25th month of disability, but it must always relate to the individual's entitlement to both Medicare Part A and Part B. When an individual enrolls in a Medicare Advantage- Prescription Drug (MA-PD) plan she/he used both the Initial Coverage Election Period and the Initial Enrollment Period (IEP) for Part D.

The Initial Enrollment Period for Medicare Part D Drug Plans (PDP) is the same as the Initial Enrollment Period for Medicare Part B (the seven month period that begins 3 months before the month an individual meets the eligibility requirement for Part B, and ends 3 months after the month of eligibility.

During the Initial Enrollment Period for Part D, individuals may make one Part D enrollment choice, including enrollment in an MA-PD plan. Individuals eligible for Medicare prior to age 65 (such as disability) will have another Initial Enrollment Period for Part D based on upon attaining age 65.

What is the Annual Election Period (AEP)?

The Annual Election Period for coverage effective in a calendar year begins October 15 of the previous calendar year and ends December 7 of the previous year. During this period, anyone who is enrolled in Medicare may enroll for the first time in a Medicare Advantage Plan; or change from one Medicare Advantage Plan to another; or return to Original Medicare from a Medicare Advantage Plan. If during this period you enroll in a Medicare Advantage Plan that includes Medicare Part D prescription drug coverage then any prior Medicare Part D Plan coverage is automatically cancelled and replaced by the new Medicare Advantage Plan with prescription drug coverage — these plans are known as MA-PD plans (Medicare Advantage-Part D plans). Enrollments during this period have an effective date of January 01. The AEP occurs October 15 through December 7 every year.

What is a Special Election Period (SEP)?

A Special Election Period means that you are allowed to enroll in Medicare Advantage after the IEP and/or AEP because you meet certain conditions set forth by the government. Below are some specific situations which might qualify you for a SEP.

You may qualify for a Special Election Period if:

Can I change my Medicare Advantage plan after I enroll?

Once enrolled in an MA or MA-PD Plan you must wait to change plans until the next Annual Election Period (AEP) every year: October 15 - December 7.

Some categories of beneficiaries are not bound by the lock-in rules and may enroll or disenroll from an MA plan in other than the AEP. An individual may at any time, during a designated Special Election Period (SEP), discontinue the election of an MA plan offered by an MA organization and change his or her election to original Medicare or to a different MA plan. Examples of situations which may entitle an individual to an SEP include the termination or discontinuation of a plan, a change in residency out of the service area, the organization violating a provision of a contract or misrepresenting the plan's provisions, or the individual meeting other exceptional conditions as CMS may provide. CMS has also designated an SEP for individuals entitled to Medicare A and B and who receive any type of assistance from Title XIX (Medicaid), including full-benefit dual eligible individuals, as well as those eligible only for the Medicare Savings Programs. This SEP lasts from the time the individual becomes dually eligible until such time as they no longer receive Medicaid benefits. Individuals who are eligible for an SEP under the guidance for Part D enrollment and disenrollment may use that SEP to also make an election into or out of an MA-PD plan.

Important Medicare Advantage Dates to Remember

October 15
Annual Election Period begins. First day you may elect to enroll in a Medicare Advantage Plan effective in the next calendar year. The plan effective date will be 01 January.

December 7
Last day you can enroll in a Medicare Advantage Plan for the next calendar year unless you qualify for an exception.

January 1
First day your Medicare Advantage/Part D Prescription Drug plan is effective.

from Medicare.gov, Glossary Definitions (Oct 2011)