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A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private insurance companies.
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get your Medicare Part A & Part B coverage from the Medicare Advantage Plan, not Original Medicare.
In all types of Medicare Advantage Plans, you're always covered for urgent and emergency care. All of them also have an annual maximum out-of-pocket limit for medical costs. If you reach that amount, the plan will pay 100% for the remainder of the year for your Medicare-approved services. Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, Original Medicare will still cover hospice care, if needed.
Most Medicare Advantage Plans offer extra coverage, like vision, hearing, dental, and other health and wellness programs. Most also include Medicare prescription drug coverage (Part D).
In addition to your Part B premium, you might have to pay a monthly premium for the Medicare Advantage Plan.
Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan's network for non-emergency or non-urgent care).
The plans are annual contracts and can change each year.
In order to be eligible to enroll in a Medicare Advantage plan, you must have Medicare Part A & Medicare Part B, live in the plan's service area, and not have End Stage Renal Disease (kidney failure).
There are timeframes for enrollment in to Medicare Advantage and Prescription Drug Plans.
Begins three months before and ends three months after the month of the individual's Medicare eligibility date (typically 65th birthday). The beneficiary can choose any type of plan during the Initial Election Period (IEP).
October 15th to December 7th
Every year, Medicare has an open enrollment period when you can make a change using your annual election period. Since all plan contracts are annual, there may be changes. Between October 15th and December 7th you can make a new plan choice that will be effective January 1 of the following year.
January 1st to March 31st
During this Open Enrollment Period (OEP), beneficiaries enrolled in a Medicare Advantage plan (MA-PD or MA-Only) can make a one-time switch to another Medicare Advantage plan (with or without Prescription Drug coverage,) or return to Original Medicare, with the option of enrolling in a Stand Alone Part D plan.
In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period.
There are several different types of Medicare Advantage plans. (Not all plans are available in all areas.)