Medicare Advantage (MA or Part C), is a popular alternative to traditional Medicare. Since 2010, enrollment increased 71 percent, with as many as one in every three eligible seniors today choosing a Medicare Advantage plan over Original Medicare. Understanding this option is a critical step in managing health care into retirement. Here are some things to consider, along with a few pros and cons of Medicare Part C.
The Differences Between Original Medicare and Medicare Advantage
Original Medicare is fairly basic. Coverage includes hospital insurance (Part A) and medical insurance (Part B). While Part A is free for most people, Part B carries a monthly premium. Prescription drug benefits (Part D) are not part of Original Medicare but can be added for an additional monthly premium.
Seniors enrolled in Original Medicare can visit any doctor or hospital they choose, as long as the provider accepts Medicare. While a good percentage of costs are covered, seniors are responsible for out-of-pocket expenses, like deductibles, coinsurance and copays. Many people add Medicare Supplement insurance (Medigap) to help shoulder some of these costs.
By contrast, Medicare Advantage is offered by private insurance companies as an alternative way to receive Original Medicare. With an MA plan, you receive Part A and Part B benefits, as well as additional benefits not covered by traditional Medicare. Most MA plans include coverage for prescription drugs, as well as dental, vision and in some cases, even hearing.
Unlike Original Medicare, with Medicare Advantage, you are limited to doctors and hospitals that are part of a specified network. Networks can be large, or narrow depending on where you live and a referral may be needed to see a specialist.
Is Medicare Advantage a Good Deal?
With comprehensive benefits and low premiums, Medicare Advantage sounds like a great deal. After all, putting together a similar plan using traditional Medicare would mean adding a prescription drug premium and maybe even Medigap to shoulder out-of-pocket costs. However, it’s important to look at your needs carefully to decide if Medicare Advantage makes sense for you.
Things to Consider
Network Availability Medicare Advantage may be a good option if the network includes providers you already use. Look carefully at which doctors are in the plan’s network, and whether or not you need a referral to see a specialist.
Out-of-pocket Expenses For those in good health who will don’t expect to visit the doctor’s office or hospital regularly, Medicare Advantage can be a great asset, offering additional benefits at a low cost. If, on the other hand, you will be visiting the doctor frequently and expect to have many copays, traditional Medicare supplemented with a Medigap plan can help with expenses.
The Bottom Line
Medicare Advantage is a great option for seniors looking for comprehensive care at an affordable price. As long as you can work within the network model, and won’t be needing a lot of specialized care, an MA plan may be a good deal.
Medicare Advantage Stats: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/
Annual Enrollment Period (AEP), is the one time of year when you can make changes to an existing Medicare Advantage or Prescription Drug plan. Basically, you have a few choices. You can join a new Medicare Advantage (MA) Plan or Prescription Drug Plan (PDP), switch between MA plans, or leave a Medicare Advantage Plan to return to Original Medicare. With many options, the Annual Enrollment Period can be confusing. Here are five frequently asked questions, with answers to help you easily navigate this important time of year.
1: When is Annual Enrollment?
A: Annual Enrollment begins on October 15th and ends on December 7th.
These dates are important to remember. If you make changes at any time during Annual Enrollment, they will take effect on January 1st. Remember, in most cases, Annual Enrollment is the only time you can move to a new Medicare Advantage or Part D plan. Be sure to do research ahead of time and be ready to switch if that’s what you decide to do.
2: I’ve read my Annual Notice of Change (ANOC), and my costs are going up. What can I do?
A: Annual Enrollment is your time to make changes to your Medicare plan.
As a member of a Medicare plan, you should receive an Annual Notice of Change in the mail by the last day of September. This important document includes any changes in costs and bhttps://www.ssiinsure.com/medicare-annual-notice-change/enefits that will impact your current plan in the upcoming year. If, after reviewing your ANOC, you no longer want to continue with the plan you have, now is the time to change. During Annual Enrollment, you may make the following changes:
Change from Original Medicare to a Medicare Advantage Plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
Join a Medicare Prescription Drug Plan.
Switch from one Prescription Drug Plan to another Prescription Drug Plan.
Drop Medicare Prescription Drug coverage completely.
Don’t forget, Original Medicare does not include prescription drug coverage. If you leave a current Medicare Advantage Plan with prescription coverage and return to Original Medicare, you will need to join a standalone Part D plan. If you do not enroll in a standalone Part D plan, a Part D penalty may apply.
3: Annual Enrollment ended, but I do not like the new Medicare Advantage Plan I joined. What can I do?
A: After Annual Enrollment ends, there is an Open Enrollment Period from January 1stto March 31st.
The Open Enrollment Period was created for people who are dissatisfied with their Medicare Advantage Plan after the Annual Enrollment Period ends. This is another time, in addition to, Annual Enrollment when you can disenroll. During this period, you can switch from a Medicare Advantage Plan to Original Medicare plus a Part D Plan or switch from one Medicare Advantage Plan to another. Any changes take effect the month after it is submitted.
4: Is Annual Enrollment the same as Open Enrollment for the Health Insurance Marketplace?
A: No. Open Enrollment for the Health Insurance Marketplace is not Open Enrollment for Medicare.
The federal health exchanges were created to provide insurance options for underinsured or uninsured Americans in need of health insurance coverage. As a member of Medicare, Annual Enrollment (Oct 15-Dec 7) is for you to change your Medicare plan only.
5: If I want to make changes to my Medicare plan, what do I need to do?
A: Joining, switching, or dropping a Medicare Advantage Plan or Prescription Drug Plan during Annual Enrollment is easy.
To join a Medicare Advantage Plan, simply enroll in the plan and your old coverage will be discontinued automatically.
To switch between MA plans, simply join the new plan and you will be dis-enrolled from the old plan automatically when your new coverage starts.
To switch from an MA plan back to Original Medicare, contact your current plan.
To join a Prescription Drug Plan, enroll in the plan you choose and coverage will begin January 1st.
Now that you’ve decided to join Medicare Advantage (Part C) as a way to receive your Medicare benefits, you may be wondering when you can enroll. Medicare only allows you to join, switch or make changes to Part C at very specific times—when you first get Medicare and during yearly enrollment periods. It’s important to know when these specific deadlines occur to avoid missing them and delaying your health care coverage.
Initial Enrollment Period
When you first become eligible to receive Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time that begins 3 months before your 65th birthday, includes your birthday month and ends 3 months after. For 7 full months, you are in your unique initial enrollment period and can sign up for Medicare Part C. In most cases, this is the best time to join. However, if you didn’t join and you already have Original Medicare, you can still join a Medicare Advantage plan during other enrollment periods.
Other Enrollment Periods
Annual Enrollment extends between October 15 and December 7. During this time, anyone can join, switch or drop a Medicare Advantage plan. As long as the plan you are requesting receives your information by December 7, your new coverage will begin on January 1. During Annual Enrollment, you can:
Change from Original Medicare to a Medicare Advantage plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage plan to another Medicare Advantage plan.
Special Enrollment periods were created for people to join and make changes to Medicare Part C when circumstances make it difficult for them to meet regular enrollment periods. For instance, if you move, lose your current coverage, have the opportunity to get other coverage or meet one of several other special situations, you can usually join, switch or drop a Medicare Advantage plan.
For example, if you are enrolled in Medicare Part C, but move to a new address with better coverage available, you have 2 months to switch plans. If you were living abroad, but are now back in the United States, you have 2 months to join a Medicare Advantage plan. Or, if you lose coverage through an employer (COBRA included) you typically have 2 months to join a Medicare Advantage plan. While there are many special circumstances that may qualify for Special Enrollment, here is a quick summary of the main conditions that meet Special Enrollment criteria:
Move to a new address, move back into the country or move into or out of a nursing home or assisted living facility.
No longer being eligible for Medicaid or extra help, or losing employer coverage.
Have your current Part C plan terminated by Medicare or not renewed.
Reviewing Coverage and Switching Medicare Advantage Plans
When the goal is to spend the least amount of money for the most amount of coverage, you owe it to yourself to get the best deal you can with Medicare Part C. Initial Enrollment is usually the best time to sign up, but once you have coverage, Annual Enrollment (Oct 15 – Dec 7) is a great time to make changes to an existing plan or switch between plans.If you miss the December 7 deadline, you can still drop your current Medicare Advantage plan and return to Original Medicare during Medicare Advantage Dis enrollment (Jan 1 – Feb 14). If you leave your plan and return to Original Medicare, you have until February 14 to join a prescription drug plan. However, you may not switch from Original Medicare to a Medicare Advantage plan or switch between Medicare Advantage plans during this time.
Even if you think your current Medicare Advantage plan meets your needs, it makes sense to look over new coverage options. Shopping around for better rates and benefits for the upcoming year is a smart way to make sure you’re getting a plan that fits your health care needs and your budget.
9 to 12 months before you turn 65
- Confirm that you are eligible to receive Medicare benefits by calling the Social Security Administration at 800.772.1213.
- Review your current health insurance policy to find out what happens with that coverage when you turn 65.
- Research options for coverage to help protect yourself from costs not included in Medicare coverage.
4 to 8 months before you turn 65
- Become familiar with Medicare and its various parts: A, B, C and D.
- Ask your doctor if they accept Medicare or participate with other Medicare plans.
- Sign-up for coverage to help protect yourself from costs not included in Medicare coverage.
1 to 3 months before you turn 65
- Enroll in Medicare Parts A and B – if you do not receive your automatic enrollment information in the mail, contact the Social Security Administration at 800.772.1213.
- Sign up for Social Security if you have decided to take early Social Security benefits (Note: it usually takes three months after you sign up before you begin receiving benefits).
- If your spouse and/or dependent are covered under your employer’s plan, make arrangements for him or her to have coverage after you have Medicare.
Happy 65th Birthday!
- If you have not received your Medicare card in the mail, call the Social Security Administration at 800.772.1213.
- Make sure your physician’s office has a copy of your Medicare Card and any supplement plan you may have signed up for.
Here’s some good news: if you’re turning 65 soon, you’ll also be eligible to join Medicare—a federally funded program that provides hospital and medical insurance to older Americans. Transitioning to Medicare for the first time can be confusing and you’re not alone if you have a few questions. Here’s a great resource to get you started—important tips and things to think about as you plan for Medicare coverage.
Enrollment In Medicare Is Automatic
If you’re worried about how to sign up for Medicare before your birthday, don’t be. For most seniors, enrollment in Original Medicare (Part A and Part B) is automatic. As long as you receive Social Security or Railroad Retirement benefits, you don’t need to do anything at all and your Medicare card will be sent to you by mail.
Expect to receive your card 3 months before you turn 65, with benefits beginning on the first day of your birthday month. If you do not receive retirement benefits, you may need to enroll in Medicare manually through the Social Security Administration or Railroad Retirement Board.
Accepting or Opting Out of Part B
While Part A (hospital insurance) is free for most people, Part B (medical insurance) is not. A monthly premium will be deducted from your Social Security check each month. In 2021, the standard Part B premium is $203 (or higher depending on income).
If you are still working, covered through an employer or a spouse’s employer, you do not need to keep Part B coverage or pay for it. You can choose to opt-out of Part B coverage on the back of your membership card.
Important tip: If you opt-out of Part B coverage, and do not have comparable coverage through an employer or spouse, you may end up paying a late enrollment penalty when you decide to join.
Initial Enrollment Period
When you first become eligible for Medicare, you enter what is called your Initial Enrollment Period. This is a 7-month period of time beginning 3 months before your birthday month, and extending 3 months after your birthday month. For example, if you were born in July, your Initial Enrollment Period would be April 1 through October 31. This is the time to enroll in Medicare (for those not enrolled automatically) or enhance coverage with additional benefits.
Important tip: If you’re looking to add additional coverage to Original Medicare, your Initial Enrollment Period is the time to do it. If you delay, you may have to wait until the General Enrollment Period (Jan 1-Mar 31) of the following year and may also be charged a late enrollment penalty.
Adding Benefits to Original Medicare
Original Medicare covers much of your health care needs, but it doesn’t cover everything. It’s up to you to decide if you want to enhance coverage with extra benefits and how. Understanding your options will make it easier to choose the perfect complement to your Medicare coverage.
There are only two ways to receive Medicare: through Original Medicare or through Medicare Advantage (Part C). Original Medicare provides Part A and Part B. Medicare Advantage Provides Part A, Part B, and additional benefits. Medicare Supplement (Medigap) insurance and Prescription Drug coverage (Part D) may be added to Original Medicare for additional benefits.
- Medicare Supplement – Medigap helps pay the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays. While there are no benefits for dental, vision, or prescription drugs, some plans provide coverage while traveling outside of the country. You are responsible for paying a monthly premium for Medigap coverage as well as your Part B premium.
- Medicare Advantage –Part C extends Original Medicare by delivering all of your Part A, Part B, and additional benefits from one plan. Dental, vision, and prescription drugs are often covered. If you join a Medicare Advantage plan, you’re still enrolled in Medicare, you simply enhance coverage with extra benefits. You are responsible for paying a monthly premium for Medicare Advantage as well as your Part B premium.
- Prescription Drug Coverage – Part D Original Medicare does not include benefits for prescription drugs. If you wish to add coverage, there are only two ways to do it: join a standalone Part D plan, or join a Medicare Advantage plan that already includes prescription drug benefits.
Important tip: you cannot combine Medicare Supplement and Medicare Advantage benefits. If you’re looking to extend benefits beyond Original Medicare, you need to decide which makes the most sense for your specific needs—extra medical benefits or help with expenses.
Cost of Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html