| Medicare Advantage Plans (Part C) |
Medicare Advantage Plans are health plan options approved by Medicare and offered by private companies. These plans are sometimes called "Medicare Health Plans", Medicare Supplemental plans or "MA plans". Medicare Advantage Plans provide your Medicare health coverage and may provide Medicare drug coverage. They are not supplemental insurance.
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Medicare Advantage Plans provide all of your Part A (Medicare Insurance) and Part B (Medicare Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. Some plans may offer extra coverage, such as vision, hearing, dental and/or health and wellness programs. Each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually copayments but can also be coinsurance and deductibles. It is important to understand a plan’s rules before enrolling.
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Medicare Advantage Plans include the following:
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Private Fee-for-Service (PFFS) Plans
- Medical Savings Account (MSA) Plans
- Special Needs Plans (SNP)
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Who can join a Medicare Advantage Plan?
You can generally join a Medicare Advantage Plan if you meet these conditions:
- You have Part A and Part B
- You live in the service area of the plan
- You do not have End Stage Renal Disease (ESRD). There are special rules for people with ESRD. For more information about ESRD, visit www.medicare.gov/Publications/Pubs?pdf/10128.pdf to view the booklet "Medicare Coverage of Kidney Dialysis and Kidney Transplant Services."
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When can you join, switch or drop a Medicare Advantage Plan?
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You can join, switch or drop a Medicare Advantage Plan at these times:
- Initial Enrollment Period – When you first become eligible for Medicare. The 3 months before you turn age 65 to 3 months after the month you turn age 65.
- General Enrollment Period – Between January 1 – March 31 each year. However, you cannot join or switch to a plan with prescription drug coverage during this time unless you already have Medicare prescription drug coverage (Part D). You can obtain prescription drug coverage and a Medicare Advantage Plan (offering prescription drug coverage) between November 15 – December 31 of each year.
- Special Enrollment Period – 1) If you move out of your plan’s service area; 2) if you have both Medicare and Medicaid; 3) if you qualify for low income subsidy ("extra help"); or 4) if you live in an institution (e.g., nursing home). Other situations may qualify you for a special enrollment period.
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Considerations for Medicare Advantage Plans
- You still have Medicare rights and protections.
- You must follow plan rules to avoid higher costs.
- You can join a Medicare Advantage Plan even with pre-existing conditions, except End Stage Renal Disease (ESRD).
- If you see a doctor who does not belong to the plan’s network, your service may not be covered or your costs could be higher.
- If the plan decides to stop participating in Medicare, you can join another Medicare health plan or return to Original Medicare.
- Many Medicare Advantage Plans offer prescription drug coverage (Part D).
- You do not need to buy a Medigap (Medicare Supplement Insurance) policy. With a Medicare Advantage Plan, a Medigap policy will not cover your deductibles, copayments or coinsurance.
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