(PART C) PLANS
Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. These plans are offered by private insurance companies contracted through CMS (Medicare) to provide a Medicare benefits package as an alternative to Original Medicare. Medicare Advantage is optional, but to obtain this private insurance, you must also have Parts A and B of Original Medicare. You must also continue to pay your Part B premium if you have a Medicare Advantage plan.
Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (hospice benefits continue to be provided under Original Medicare), but these benefits are provided in a different form, usually with copays and coinsurance. The value of the Part A and B benefits offered in a Medicare Advantage plan on an overall basis must be actuarially equivalent to Part A and B benefits provided through Original Medicare. Many Medicare Advantage plans include prescription drug coverage.
Plan provisions differ between carriers and between plans offered by the same carrier.
Medicare Advantage plans may even cover certain health care services that Part A and B of Original Medicare do not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.
LEARN MORE about Medicare Advantage (also called “Part C”) plans.
Medicare Advantage Plans FAQsSelect an item from the list to view information for that item.
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1. When Can I Enroll In A Medicare Advantage Plan?
The primary times to enroll for Medicare Advantage or Medicare Part D prescription drug plans are:
- During your Initial Enrollment Period which is usually the seven month period beginning three months before and ending three months after your 65th birthday month. Plans (and Medicare) are always effective the first of the month. If your birthday is the first of the month, your birth month is considered to be the first day of the preceding month; or
NOTE: see the answer to FAQ 2 following that describes the new Open Enrollment Period that will be implemented in 2019. Members who have previously enrolled in a Medicare Advantage or Medicare Advantage Prescription Drug Plan can change to a different Medicare Advantage or Medicare Advantage Prescription Drug Plan on a one-time basis between January 1 and March 31.
- During the Annual Election Period (AEP) which starts October 15 and ends December 7. The effective date of enrollment is the following January 1. This is the time to review your present plans and coverages and decide if you want to make any changes. Unless you have a special election period, this is the only other time (see the following note for the exception) you can enroll in or change to a different Medicare Advantage or Part D Prescription drug plan.
2. What Is The Open Enrollment Period (Replaces The Medicare Advantage Disenrollment Period)?
The Medicare Advantage Disenrollment Period (which formerly ran from January 1 to February 14) has been eliminated effective in 2019 and been replaced by the Open Enrollment Period, which runs from January 1 through March 31, 2019. During this period a person enrolled in a Medicare Advantage or Medicare Advantage Prescription Drug plan can elect to return to Original Medicare and also select a Medicare Supplement Plan and stand-alone Prescription Drug Plan) or make a one-time change to a different Medicare Advantage or Medicare Advantage Prescription Drug plan.
The primary reason for making this change in enrollment periods is that some members find that the network for their Medicare Advantage plan is inadequate or that their primary or specialist doctor(s) may have left the network. This new Open Enrollment Period has been initiated to provide these members an opportunity to change to a plan that corrects this problem.
An individual with a Medicare Supplement or with "Original Medicare" (only) can not make an election during this period, nor can an individual with a stand-alone Prescription Drug Plan switch to another stand-alone Prescription Drug Plan.
3. What Is A Special Enrollment Period?
These individuals are eligible for special election periods that permit them to enroll in a Medicare Advantage plan throughout the year:
- *Medicaid beneficiaries
- *Individuals on low income subsidy ("extra help" in paying for prescription drugs);
- People with chronic conditions like diabetes, chronic heart failure, COPD, and dementia (if a plan specializing in their condition exists in their service area);
- People moving out of a plan’s service area; and
- Those affected by other situations (including plan termination or insolvency).
* Effective in 2019, Medicaid and "extra help" beneficiaries (who formerly could change plans at any time with an effective date the first of the following month) can change plans once per calendar quarter. If a change is made in the first three quarters, the change is effective the first of the following month. If a change is made in the fourth calendar quarter, the change is effective the following January 1. The special election period chart (first line above) has not yet been updated to reflect this change.
Please call us at 877-734-3884 for additional details including eligibility, available enrollment dates and help in enrolling.
4. What Special Enrollment Procedures Apply To Five-Star Plans?
A special enrollment period permits eligible beneficiaries to enroll in a five-star plan at any time of the year between December 8 of the current year and November 30th of the following year for a first of the following month effective date. LEARN MORE.
5. Where Can I Find Available Plans?
For a complete listing of plans available in your service area please contact 1-800-Medicare or go to the Medicare Plan Finder at www.medicare.gov (TTY users should call 877-486-2048)
Your copy of Medicare & You 2019 also contains a generalized listing of the plans available in your area for 2019 but these listings do not contain complete details. Medicare & You 2019, which you should have received in late September or early October, 2018 receive in late September 2018 contain a generalized listing of plans available in your area for 2019. You should consult the Summary of Benefits or Evidence of Coverage for each plan for more information.
Call us at 877-734-3884 for more information and help in enrolling in a plan.