Medicare Part C (Medicare Advantage)
What Is a Medicare Advantage Plan?
Medicare Part C, commonly known as Medicare Advantage insurance, typically consolidates various Medicare coverage aspects into a single health plan. This option is presented by private insurance companies in partnership with CMS, offering an alternative Medicare benefits package distinct from Original Medicare.
Participation in Medicare Advantage is voluntary, but to enroll in this private insurance, individuals must also continue to be enrolled in Part A and Part B. Additionally, you must continue to pay your Part B premium when opting for a Medicare Advantage plan. While these plans are obliged to deliver all benefits under Medicare Part A and Part B (excluding hospice care), private insurers have the flexibility to incorporate diverse supplemental benefits.
Many Medicare Advantage plans feature prescription drug coverage, potential reductions in deductibles, and decreased out-of-pocket expenses. Moreover, these plans may extend coverage to services not included in Original Medicare, such as eye exams, hearing aids, dental care, or healthcare received during international travel. The specifics of additional benefits can vary between individual private health insurers.
Is Medicare Part C (Medicare Advantage) Right For You?
Recent data on Medicare Advantage enrollment reveals a significant uptick, nearly doubling from 2010 to 2020. In 2020, an impressive 36% or 24.1 million individuals opted for Medicare Advantage. To put this in perspective, back in 2000, only 17% of all Medicare beneficiaries (totaling 6.8 million people) chose a Medicare Advantage Plan.
When it comes to selecting a Medicare plan, you have choices. It's crucial to comprehend the offerings of each plan and assess how well they align with your lifestyle. Let's explore the various options available to you.
What Are The Types Of Medicare Advantage (Part C) Plans?
Medicare Advantage (Part C) plans come in several types, each offering different coverage options. The main types of Medicare Advantage plans include:
Health Maintenance Organization (HMO) Plans: Require members to use a network of healthcare providers and typically need referrals to see specialists.
Preferred Provider Organization (PPO) Plans: Allow members to use both in-network and out-of-network providers without referrals, but using in-network providers is usually more cost-effective.
Private Fee-for-Service (PFFS) Plans: Determine how much they will pay to healthcare providers and how much the member pays when care is received.
Special Needs Plans (SNPs): Cater to individuals with specific health conditions or characteristics, providing specialized care and services.
Medicare Medical Savings Account (MSA) Plans: Combine a high-deductible health plan with a medical savings account, and Medicare deposits money into the account.
Institutional Special Needs Plans (I-SNPs): Tailored for individuals who reside or are expected to reside in institutions, such as nursing homes.
Selecting the appropriate Medicare Advantage plan type relies on individual healthcare needs and preferences.
What Is The Eligibility For Medicare Advantage Plans?
Eligibility for a Medicare Advantage plan is contingent on meeting the criteria for Original Medicare, specifically Part A and Part B (unless diagnosed with End-Stage Renal Disease). Typically, having Medicare Part A and Part B qualifies you for Medicare Part C, but residency in the service area of your chosen Medicare Advantage plan is essential.
If you possess additional health insurance coverage, such as through an employer or union, it's advisable to consult your plan administrator regarding specific rules before enrolling in a Medicare Advantage plan. Enrollment decisions may impact existing coverage, and certain plans may not be recoverable if you change your mind later.
Medicare Advantage plans have specific enrollment periods:
Initial Coverage Election Period (ICEP): This seven-month window, starting three months before turning 65, includes the birthday month and ends three months after. For instance, if Medicare coverage begins in May, the ICEP spans from February through August.
Annual Election Period (AEP): Occurring from October 15 to December 7 annually, AEP permits changes to Medicare Advantage or Prescription Drug Plans, with the selected coverage starting on January 1 of the following year. Beneficiaries can add, change, or drop their existing coverage during this period.
Medicare Advantage Open Enrollment Period (OEP): Running from January 1 through March 31, this period allows individuals who are enrolled in a Medicare Advantage plan to switch to a different Medicare Advantage plan (back to your previous plan or a new one). It also allows Advantage plan beneficiaries to switch back to Original Medicare. If losing prescription coverage due to the change, enrollment in a standalone Medicare Part D Prescription Drug Plan is also an option.
Special Election Period (SEP): Life events may qualify individuals for a SEP outside the AEP. Examples include moving outside the plan's service area, qualifying for Extra Help in prescription drug costs, or moving into an institution like a nursing home.