Medicare Advantage (Part C)
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you may need to use your Medicare card for some services. Also, you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans.
Other less common types of Medicare Advantage Plans that may be available include: HMO Point of Service (HMO-POS) Plans and a
Medicare Medical Savings Account (MSA) Plan.
Know the differences between plans.
How do Medicare Advantage Plans work?
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, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and your Part D (Prescription Drug Coverage) from the Medicare Advantage Plan and not Original Medicare.
Do Medicare Advantage Plans cover all Medicare services?
Medicare health plans provide Part A and Part B benefits to people with Medicare who enroll in these plans, which include Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
Medicare Advantage Plans must follow Medicare's rules
Medicare pays a fixed amount for your care 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 in-network doctors, facilities, or suppliers that have a contract with the plan when seeking non-emergency or non-urgent care). These rules can change each year.
What are the costs for Medicare Advantage health plans?
Prices vary depending on the type of plan you chose if your plan has a network and what medications you need covered. Working with an agent will help you get the "best bang for your buck".
How does Drug coverage work for a Medicare Advantage Plan?
You usually get prescription drug coverage through the Advantage plan. There are Advantage plans that don't offer drug coverage. You may choose this type of plan if you have the VA or other type of creditable drug coverage, otherwise you may incur a Part D penalty for not having “creditable Rx coverage” It is important to discuss with a qualified agent.
In most cases you cannot have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
Medicare General Enrollment Period - 2023
The Medicare General Enrollment Period for 2023 is the first time enrollees can sign up for coverage that begins on the first day of the following month. In previous years, signing up for Original Medicare during the General Enrollment Period meant waiting until July 1 for your coverage to go into effect. Thus, those who had to pay late enrollment penalties accrued extra late fees for the months between their enrollment and July 1. Now, Medicare hopes to reduce late enrollment penalties by allowing coverage to begin earlier than before.
Medicare’s General Enrollment Period
The Medicare General Enrollment Period allows you to sign up for coverage if you missed your Initial Enrollment Period and do not have a Special Enrollment Period. You can use the Medicare General Enrollment Period to apply for Medicare Part A or Part B at any time in January, February, or March. When you use this enrollment period, your coverage is effective the first day of the following month. Meaning you will not need to wait longer to use your benefits. Often, when you enroll during the General Enrollment Period, you will likely be responsible for a late enrollment penalty. Therefore, it is vital to apply when you first become eligible. Choosing to lapse in coverage is not wise, especially after age 65.
After enrolling in Original Medicare, you will be eligible for a Medicare Supplement (Medigap) or Medicare Advantage plan. So, if you want to enroll in either coverage type, you should ensure the effective date is the same as for your Original Medicare.
You can enroll in a Medigap plan at any time. However, outside of your Medicare Supplement Open Enrollment Period, you must go through the underwriting process, which means you may face denial due to pre-existing conditions. In addition to Medigap, it is wise to enroll in a Medicare Part D plan if you do not already have creditable drug coverage for Medicare.
There is also a Medicare Part D late enrollment penalty. So, if you do not have drug coverage at least as good as Medicare, enrolling in a plan will save you from paying the penalty later. On the other hand, you will also receive an Initial Coverage Election Period for Medicare Advantage if you do not enroll in a Medigap plan. You must register in a Medicare Advantage plan before your Part B effective date.
General Enrollment Period for Medicare Part B
Suppose you enroll in Medicare Part A during your Initial Enrollment Period and delay Medicare Part B. In that case, you could use the General Enrollment Period to sign up for Medicare Part B benefits if you do not qualify for a Medicare Part B Special Enrollment Period.
To qualify for a Special Enrollment Period, you must have creditable coverage. Creditable coverage prevents you from paying the Medicare Part B late enrollment penalty. However, suppose you do not have creditable coverage. In that case, the next time you can enroll in Original Medicare is during the General Enrollment Period, and a late enrollment penalty may be applicable. You must enroll in Medicare Part B during the General Enrollment Period and pay the late enrollment penalty.
Can I Delay Medicare Part B During the General Enrollment Period?
The only circumstance in which you may delay Medicare Part B while avoiding a late enrollment penalty is if you have employer coverage through your job or your spouse. If you delay Medicare Part B enrollment due to creditable coverage, such as group coverage through your employer, you do not have to worry about the late enrollment penalty. Thus, enrolling in Medicare Part A only during the General Enrollment period is not an issue. When you retire, you get a Special Enrollment Period for Medicare Part B. You will not need to wait until the next General Enrollment Period to get coverage.
How Does the General Enrollment Period Work with Medicare Part D?
When you enroll in either Medicare Part A or Part B during the General Enrollment Period, you will receive a Medicare Part D Special Enrollment Period to choose your Medicare Part D prescription drug coverage. If you sign up for Original Medicare during the General Enrollment Period, you can apply for a Medicare Part D plan. The Medicare Part D late enrollment penalty is 1% of the average Medicare Part D plan premium for each month you delay Medicare Part D coverage. For example, if you delay Medicare prescription drug coverage for 25 months, you will be charged 25% of the average Medicare Part D plan on top of your chosen plan’s premium. Suppose you do not sign up for prescription drug coverage when you first become eligible for Medicare and lack creditable coverage. In that case, you will need to pay the monthly penalty with your premium. However, this penalty is calculated by the number of months you delayed coverage rather than years.
Just some of the carriers we work with
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to gather information regarding all your options. This is a proprietary website and is not associated with, endorsed by, or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare, and services for people with Medicare. If you would like to find out more information regarding Medicare, please visit the Official U.S. Government Site for People with Medicare located at https://www.medicare.gov/