Medicare Advantage FAQ

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Medicare Advantage FAQ 2017-08-24T12:34:18+00:00
  • Medicare Advantage plans must cover all of the medical and hospital services that Original Medicare covers, except hospice care (Original Medicare covers hospice care even if you’re enrolled in a Medicare Advantage plan).
  • All types of Medicare Advantage plan options cover emergency and urgent care.
  • Medicare Advantage plans may offer additional coverage, such as routine vision and dental services, hearing benefits, or memberships to health and wellness programs.
  • Many plans include Medicare prescription drug coverage, as mentioned above.

You can generally qualify for a Medicare Advantage plan if you meet these conditions:

  • You have Medicare Part A and Part B coverage.
  • You live in an area serviced by the Medicare Advantage plan you want to enroll in.
  • You don’t have end-stage renal disease (ESRD – permanent kidney failure requiring dialysis or a kidney transplant), in most cases. There are exceptions, so if you have ESRD and want to get a Medicare Advantage plan, contact the plan you’re considering and ask.

The costs of a Medicare Advantage plan can vary from one plan to another and one location to another. Here are some questions to consider when deciding on a Medicare Advantage plan:

  • Does the plan charge a monthly premium in addition to your Medicare Part B premium?
  • How much will you pay for each service or visit (copayments or coinsurance), both in-network and out-of-network?
  • Does the plan have an annual deductible?
  • What’s the maximum out-of-pocket limit? (Every Medicare Advantage plan has one.)
  • Does this plan have network restrictions? Will you be using network providers or out-of-network providers?
  • Do you have certain doctors and specialists you prefer to keep? Are they in the plan’s network?
  • If the plan covers prescription drugs, are all your medications covered?
  • Are there any additional benefits in the plan, such as routine vision or dental coverage? Do you need them? What do these benefits cost?

Because the costs and additional benefits vary among plans, you might want to compare Medicare Advantage plans in your area.

There are a few time periods when you can enroll in a Medicare Advantage plan.

  • The Initial Coverage Election Period (ICEP) begins three months immediately before you are entitled to both Medicare Part A and Part B. The ICEP ends either the last day of the month before you have both Part A and Part B or the last day of the Part B Initial Enrollment Period, whichever is later.
  • If you’re enrolled in Original Medicare during your Medicare Initial Enrollment Period (IEP), automatically or otherwise, your Initial Coverage Election Period and your Initial Enrollment Period happen at the same time. The Initial Enrollment Period starts three months before the month you turn 65, includes your birth month, and ends three months after that (seven months total). If you didn’t sign up for Original Medicare during the Initial Enrollment Period (if you still have health insurance through an employer or union, for example), your Initial Coverage Election Period is the 3-month period before your Medicare Part B start date. For example, if you enrolled in Medicare Part B during the General Enrollment Period (January 1–March 31), your Part B start date would be July 1, so your Initial Coverage Election Period would be April 1 to June 30.
  • The Annual Election Period (AEP) runs from October 15 to December 7 each year. You can switch from Original Medicare to a Medicare Advantage plan at this time, and make other coverage changes. If you’re already enrolled in a Medicare Advantage plan and want to switch plans, in most cases a good time to do so is during the Annual Election Period.  When you change Medicare plans during the Annual Election Period, your new coverage generally begins on January 1 of the following year.
  • In some cases, you may be able to change Medicare Advantage plans during Special Election Periods (SEPs). Situations that qualify you for a include (but are not limited to) moving to a new address, losing your current coverage, qualifying for other coverage, or changes in your current plan that affect your health benefits.
  • If you’re enrolled in a Medicare Advantage plan and want to switch back to Original Medicare, Part A and Part B, you can do so during the AEP (described above) or during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year.