Medicare Plans

How Medicare Advantage Plans Work

Medicare Advantage Plans (Part C)

A Medicare Advantage Plan (like an HMO or PPO) is another health coverage choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. In all plan types, you are always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. Medicare Advantage Plans aren't considered supplemental coverage.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage. In addition to your Part B premium, you may have a monthly premium to pay for your plan. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

Medicare Advantage Plans include the following:

• Health Maintenance Organization (HMO) Plans.
• Preferred Provider Organization (PPO) Plans.
• Private Fee-for-Service (PFFS) Plans.
• Medical Savings Account (MSA) Plans.
• Special Needs Plans (SNP).

When Can You Join, Switch or Dis-enroll from a Medicare Advantage Plan?

Enrolling into Medicare Advantage or switching plans may be done at these times:

• You can join when you first become eligible for Medicare (the 7 month period that begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65).
• If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. You will have another chance to join 3 months before the month you turn age 65 to 3 months after the month you turn age 65.
• Plan changes may be requested during the Annual Election Period, which runs from October 15 - December 7 each year. Your new coverage begins on January 1 of the following year, as long as your enrollment request is received by the plan on time.

You can dis-enroll from Medicare Advantage and return to original Medicare during these times:

• During the Annual Election Period (timeframe noted above).
• During the Medicare Advantage Disenrollment Period (runs from January 1 – February 14 each year). If you switch to Original Medicare during this period, you will have until February 14 to join a Medicare Prescription Drug Plan if you want to add drug coverage.
• Join, switch, or drop a Medicare Medical Savings Account Plan.

In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch or dis-enroll from a Medicare Advantage Plan at other times. Some of these situations include the following:

• If you move out of your plan's service area
• If you have both Medicare and Medicaid (known as “Dual” eligibility)
• If you qualify for Extra Help to pay for your prescription drug costs
• If you live in an institution (like a nursing home)

New in 2012

Special Enrollment Periods

Special Enrollment Periods are periods besides the Open Enrollment Period during which beneficiaries can change their Medicare plans. They have, up until now, been only been available if a Medicare beneficiary is moving out of an area of current service, has special needs, or is living in an institution such as a nursing home. However, there is now a different Special Enrollment Period extending to November 30, 2012, applicable to 5-star rated Medicare Advantage plans. During this Special Enrollment Period, any Medicare beneficiary living in the service area of a 5-star Medicare Advantage plan is able to change to it at any point. This Special Enrollment Period may only be used once per year.

Incentives for Medicare Advantage

Some new regulations on Medicare Advantage programs have made it more desirable. First, Medicare Advantage plans as of 2012 will be prohibited from having higher cost-sharing requirements for key medical services (including chemotherapy and skilled nursing care). Second, there are only slight changes being made in payment amounts from Medicare to Medicare Advantage programs; although administrative costs will be limited starting in 2014, the switch from administration to added benefits is already starting. Third, some Medicare Advantage programs may decide to limit range to ensure greater quality of coverage.

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• The Different Parts of Medicare
• When Do I Sign Up for Medicare Parts A & B?
• How Much are Medicare Premiums, Deductibles and Coinsurance Rates in 2012?
• Can I Choose Medicare Advantage (Part C) Instead of Medicare Parts A & B?
• How Medicare Advantage Plans Work
• Are There Other Kinds of Medicare Health Plans?
• What Are My Options for Medicare Prescription Drug Coverage (Part D)?
• What Are Medigap (Medicare Supplement Insurance) Policies?
• What Are the Changes Being Made to Medigap on June 1st, 2010?