Medicare Part C, often referred to as Medicare Advantage Plans (MA plans), are plans that are offered by private insurance companies that have been approved by Medicare. So, if you join a Medicare Advantage plan, you will still have Medicare, however, you will get your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage plan and not from Original Medicare. MA plans must provide all of the same coverage that Original Medicare does, but it may also offer some added coverage such as vision, dental, hearing and prescription drug coverage.
How It Works:
Medicare pays a fixed amount each month to the companies that provide MA plans and these companies are required to follow the rules set by Medicare. However, Medicare Advantage plans can charge different out of pocket costs, and may have different rules for how you you get your services, such as whether or not you will need to get referrals for specialist services if you need to be seen by one, and you may be required to only see doctors, or be treated in facilities within the network. These rules can change every year. Medicare Advantage plans may save you some money because out of pocket costs with these plans can sometimes be less than that of Original Medicare. Pricing varies by plan provider, so it is worthwhile to check out all of the plans available in your area. Costs will vary by the services you use and the plan you acquire.
You Can Generally Join an MA Plan If:
- You live within the service area of the plan you want to join
- You are eligible for Part A and Part B, Original Medicare coverage
- You Do Not have end stage renal disease (ERSD), which is permanent kidney failure that requires dialysis or a kidney transplant.
You will want to make sure that you choose your plan carefully. Outside of when you first become eligible to enroll in an MA plan, or if you have a circumstance that places you in a Special Election Period (SEP) you are only able to change plans once a year, during the Annual Election Period. The Annual Election Period is an open enrollment period for MA and Medicare prescription drug coverage that takes place every year from October 15 to December 7th.
Here Are 3 Important Things You Should Know About MAs:
- Most MA plans come with Prescription Drug coverage, though some do not. If you enroll in a plan that does not offer prescription drug coverage, you can join a Prescription Drug Coverage Plan. BUT you cannot have prescription drug coverage through an MA plan AND a Medicare Prescription Drug Plan. If this were to happen you would be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
- If you have an MA plan, it is illegal for anyone to try and sell you a Medigap policy UNLESS you are switching back to original Medicare. Contact your State Insurance Department if this happens to you.
- If you are unhappy with your current MA plan, there is a Medicare Advantage Disenrollment Period (MADP) that last from January 1st to February 14th of each year. During this time period a beneficiary can switch from their current MA plan back to Original Medicare.
Do you need help deciding which Medicare plan to choose? Download our Medicare Supplement Questionnaire
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