How Medicare Advantage (Part C) Enrollment Works

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How Medicare Advantage (Part C) Enrollment Works

We’ve said it once, and we’ll say it a thousand times: Medicare is confusing. Medicare Plan Finder has been helping seniors & medicare eligibles get into the right plan with the right coverage for more than a decade. We have Medicare agents in 38 states across the United States, and we’re growing every day. We’ve helped thousands and thousands of beneficiaries enroll in Medicare for the first time and we’ve helped thousands more switch into better Medicare plans. We know it’s confusing. That’s why we’re here.

How Medicare Advantage (Part C) Enrollment Works Includes:

What is a Medicare Advantage Plan and What Does it Cover?

Medicare Advantage plans are NOT the same as traditional Medicare. Traditional, otherwise known as “Original” Medicare is a government-funded program, but Medicare Advantage plans are owned by insurance companies. All American citizens are eligible for Original Medicare upon turning 65. Original Medicare includes “Part A,” hospital stay coverage, and “Part B,” medical coverage. Then, all seniors and medicare eligibles are eligible to enroll in a separate prescription drug plan known as “Part D.” At this point, you’re probably wondering - “that’s A, B, and D...what about Part C?”

Do I Need Medicare Part C?

Medicare Part C is the same as Medicare Advantage. One of the most common questions we get is, “Do I need Medicare Part C?” You are not required to enroll in Medicare Part C, but we recommend it for most clients. Part C actually includes Original Medicare, but it adds on a lot of other great benefits that Original Medicare cannot provide. For example, every Medicare Advantage plan includes that “Part D” that we mentioned before (prescription drug coverage). By enrolling in Part C, you’ll get Original Medicare + Part D + other benefits like dental, hearing, vision, fitness, transportation, and more.

MAPD (Medicare Advantage Prescription Drug Plans)

When shopping for a Medicare Advantage plan, you can purchase an MA plan or an MAPD plan. MAPD stands for Medicare Advantage Prescription Drug plan and is a more comprehensive Medicare Advantage plans. MAPDs always include prescription drug coverage. If you don't have another form of prescription drug coverage, you'll probably want an MAPD Medicare plan.

What is the Difference Between Traditional Medicare and Medicare Advantage?

In short, traditional Medicare is a government program, but Medicare Advantage plans are owned and operated by private insurance companies. However, that does not mean that Medicare Advantage is any less regulated than traditional Medicare. It’s actually quite the opposite. CMS, the Centers for Medicare and Medicaid Services, heavily regulates Medicare Advantage and sets limits on what benefits carriers can offer. Regardless, Medicare Advantage plans offer many more benefits than traditional Medicare.

Understanding Medicare Advantage Plans

Thanks to new laws passed in 2018, Medicare Advantage plans have some flexibility when it comes to benefits. Medicare Advantage plans can cover “daily maintenance” items like wheelchair ramps and home modifications as well as durable medical equipment, home health services, and telehealth. They can also cover transportation services to help you get to your doctor’s office or pharmacy.

Types of Medicare Advantage Plans

There are six major types of Medicare Advantage plans. The first four are commonly referred to as Coordinated Care plans. Not all options are available for everyone.

  • HMO Plans (Health Maintenance Organization) – You’ll select one primary physician and will only receive coverage for that one doctor unless he or she recommends that you see a certain specialist (like a cardiologist or dentist).
  • HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
  • PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will be lower if you choose one that is in your network.
  • PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
  • SNP (Special Needs Plans) Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
  • MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.

Medicare Advantage Enrollment By State

The plans you are able to enroll in will vary based on where you are located. Most Medicare Advantage plans are only available in certain states and counties. Each plan will be customized to its location and will have its own provider network. Your doctors and pharmacists will most likely not accept every plan, so a good place to start would be figuring out what Medicare Advantage plans your favorite doctor and pharmacy accept.

Medicare Advantage Plans Cost Comparison

In some cases, Medicare Advantage plans may appear to be more expensive than Original Medicare. However, if costs are higher, it's because you're getting more coverage. Some MA plans are cheaper than others, but generally the more expensive plans provide more benefits.

Have Questions? Ask a Benefits Advisor in Your Area

Medicare Advantage Enrollment Period

As you may know, every Medicare beneficiary begins with an “Initial Enrollment Period.” The IEP lasts from three months before your 65th birthday through three months after. During that time, you can enroll in traditional Medicare or you can choose to enroll in a Medicare Advantage plan. If you do not enroll in Medicare Advantage during your IEP, you have one other chance to do so every year. That time is known as the Annual Enrollment Period, or AEP, and it occurs every October 15 through December 7.

Late Enrollment Penalty

If you neglect to enroll in any Medicare plan during your IEP, you may be stuck with a late enrollment penalty fee. The penalty is designed to encourage you to enroll as early as you are eligible. Even though you can enroll in Medicare Advantage or change into a new Medicare Advantage plan during the AEP every year, you still need to enroll in Medicare when you are first eligible (during your IEP).

Special Enrollment Periods

If you are eligible for Medicaid, a Medicare Savings Program, a State Pharmaceutical Assistance Program (SPAP), a SNP (Special Needs Plan), or Social Security benefits, you are also eligible for a special enrollment period! That means that during each of the first three quarters of the year, you have one opportunity to switch plans if you discover a plan that is better for your needs.

Additionally, some circumstances will allow Medicare beneficiaries a temporary special enrollment period. If you move to a new service area (like a new county), lose or gain a job, move into or out of a facility, leave imprisonment, or lose Medicaid eligibility, you will be granted a 60-day period to find a new plan that better fits your needs.

Medicare Advantage Disenrollment Period

While there is no longer a true “disenrollment period,” you do have a few options if you do not like your Medicare Advantage plan. You can switch to a different type of plan during the Annual Enrollment Period, or you may be eligible for the Open Enrollment Period (OEP).

OEP is for individuals who enrolled in a Medicare Advantage plan during AEP but realized quickly that they chose the wrong plan of the options available to them. If you realize that the plan you chose does not actually cover everything you need it to, or your doctor is not in your network, you can make one change from January 1 through March 31. Keep in mind - this is not open to everybody. It is only available to those who switched into a new Medicare Advantage plan during the fall prior to the OEP.

What is Medicare Supplement Insurance?

Unlike Medicare Advantage, Medicare Supplement enrollment is available during all times of the year. Medicare Supplement insurance, often called “Medigap,” is actually much different from Medicare Advantage. While Medicare Advantage plans add great benefits like fitness, dental, vision, and hearing, most Medicare Supplement plans only add financial benefits, like added coverage for your deductibles, copayments, and coinsurance.

Who is Eligible for Medicare Advantage Plans?

You are eligible for Medicare Advantage as long as you live in a service area that offers it and you already have Original Medicare (Part A and Part B). The only exception is for those who have ESRD (End-Stage Renal Disease). There are only a few Medicare Advantage plans that will cover people who have ESRD, and they only exist in a few specific service areas. A Medicare Plan Finder agent in your area can help you find out if there is an ESRD-friendly Medicare Advantage plan available to you.

How Do I Get a Medicare Advantage Plan?

You’re in the right place! Medicare Plan Finder is a great place to start for getting a Medicare Advantage plan. As we mentioned, we have agents in 38 states. If you request a call or give us a call now, we can help you find out if there is an agent available in your area. If so, we can send the agent out to meet with you and discuss your Medicare options.

You can blindly sign up for Medicare online, or you can have an expert go through all your options with you and find ways for you to save money. Our agents are licensed to sell with multiple insurance carriers in your area, offering you a bias-free approach.

Give us a call at 1-844-431-1832.

Have questions? Ask a Benefits Advisor!