A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare.
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, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every 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 only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
There are other less common types of Medicare Advantage Plans that may be available:
In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan's Web site. Medicare also has information on quality to help you compare plans.
Medicare Advantage (MA) plan options are limited by the county you reside in. These plans come as HMO, PPO and PFFS options. They are available with prescription drugs (MAPD), and without prescription (MA) benefits.
Annual Enrollment Period (AEP) is a specific time each year when you can change plans. During the AEP you can switch from one you switch from one plan to any other plan that is available in your county (as long as you do not have "final stage renal failure"). You can move from MAPD to MAPD, MA to MA, MAPD to MA and MA to MAPD.
If you do not select a plan with prescription benefits (MA) at your enrollment, you will not be able to make a change until the next AEP to a plan which cover prescription drugs (MAPD).
During the AEP you can also switch from a Medicare Supplement (Medi-Gap) plan with or without a Prescription drug plan (PDP) to an MA or MAPD plan. This is also the time where you can move from an MA or MAPD plan to a Medicare Supplement. To do this you will need to complete an application with a health questionnaire. AEP starts October 15th and ends on December 7th for a January 1st effective date. Other than this time, you would need to have a Special Enrollment Period (SEP) available to you.Acronyms Index
If you’re happy with your current Medicare Prescription Drug Plan and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.
If you have Original Medicare and you want Medicare prescription drug coverage, you can:
Note: If you didn’t join a Medicare drug plan when you were first eligible, you may have to pay a penalty to join later.
If you’re happy with your current Medicare Advantage Plan with drug coverage and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.
If you’re happy with your current Medicare Advantage Plan that DOESN’T cover prescription drugs and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue. If you want to add Medicare drug coverage to this plan, call your current plan to speak to a representative. Note that if you didn’t add Medicare drug coverage when you were first eligible, you may have to pay a penalty to add it later.
Call your employer or union benefits administrator to find out how their coverage works with Medicare. You may not be able to have both Medicare drug coverage and your employer/retiree drug coverage at the same time. Joining a Medicare drug plan may limit or end your employer or union coverage for you and/or any family members covered by your plan.
You can apply for Extra Help paying for Medicare prescription drug coverage anytime by filling out and mailing an application to Social Security. There’s no cost or obligation to apply.
Call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply online at www.socialsecurity.gov.
You qualify for Extra Help paying for Medicare prescription drug coverage for one of these reasons:
Important details and dates
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