Medicare Advantage (Part C)

Coverage & Plan Types

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, you still have Medicare. You will get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage through the Medicare Advantage Plan and not Original Medicare.

In addition to Parts A and B benefits, Medicare Advantage Plans often include supplemental benefits such as vision, dental and hearing, in addition to Prescription Drug benefits.

The types of plans included through Medicare Advantage include:

  • HMO –Health Management Organizations
  • PPO – Preferred Provider Oragnizations
  • PFFS – Privates Fee for Services
  • SNP – Special Needs Plans
  • MSA – Medical Savings Account

New Enrollees

If you are turning 65 and are new to Medicare, you may enroll at any during the month you turn 65, as well as the three months prior or the three months following.

If you enroll prior to turns 65, coverage will begin the first day of the month you turn 65. If you join the month you turn 65 or three months following, coverage will begin the first day of the month following the month you enrolled.

Currently Enrolled You do not need to re-enroll in Medicare each year. Your coverage will continue from year to year if you do not elect to make changes to it. However, each year you will have a change to review your coverage and make changes.

There are two enrollment periods each year:

  1. Open Enrollment: October 15th to December 7th
  2. Medicare Advantage Disenrollment: January 1st to February 14th

During open enrollment periods there is no penalty to

  • Change from Original Medicare to Medicare Advantage Plan
  • Switch from a Medicare Advantage Plan that does not offer drug coverage to

During Medicare Advantage Disenrollment there is no penalty to:

  • Switch from Original Medicare to a Medicare Advantage Plan
  • Switch from one Medicare Advantage Plan to another

Drug coverage in Medicare Advantage Plans

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan. You can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these are true:

  • You’re in a Medicare Advantage Plan that includes drug coverage
  • You join a Medicare Prescription Drug Plan

Medigap & Medicare Advantage Plans

If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.

If you want to cancel your Medigap policy, contact your insurance company. If you leave the Medicare Advantage Plan, you might not be able to get the same, or in some cases, any Medigap policy back unless you have a “trial right.”

If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare. Contact your State Insurance Department if this happens to you. If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you’re able to disenroll.

If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining.

  • If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.
  • The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Prescription Drug Plan (Part D).
  • If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.

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Medicare Supplement

Medicare Supplement plans (Medigap) cover “gaps” in Original Medicare (Parts A & B). Each state approves a set of coverage options.

Medicare Advantage (Part C)

Medicare Advantage Plan work like an HMO or PPO health plans and help to limit out of pocket expenses. Plans may also include prescription drug coverage.

Medicare Part D Plans

Medicare Part D Plans have a list of covered medications called a Formulary. Medications on the Formulary will be covered as part of Part D.