What Is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is a type of Medicare health plan offered by private insurance companies. It provides an alternative to Original Medicare (Medicare Part A and Medicare Part B) for hospital insurance and medical insurance. Medicare Advantage plans have at least the same benefits as Original Medicare, but these types of plans typically offer more coverage. In addition to hospital and medical costs, many Medicare Advantage plans cover dental, vision, and hearing services. Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D).
Medicare Advantage coverage is offered by Medicare-approved private insurance companies instead of being managed directly by the federal government. However, plans must follow Medicare’s coverage rules. Plans must also provide members with the same protections as Original Medicare. In most cases, Medicare Advantage enrollees will need to use health care providers that participate in the plan’s network and service area. Therefore, a Medicare Advantage plan typically offers a limited selection of physicians and facilities compared with Original Medicare.
Medicare Advantage plans range in cost and coverage levels, which lets you compare plans and select one that meets your specific needs. The availability of plans depends on your geographic location and the health insurance provider. The most common types of Medicare Advantage plans are health maintenance organization (HMO) plans and preferred provider organization (PPO) plans, followed by private fee-for-service (PFFS) plans and special needs plans (SNPs).
People who are eligible for Original Medicare (Medicare Parts A and B) are also eligible to enroll in a Medicare Advantage plan if they’re at least 65 years old or have a qualifying disability. Enrollees must also:
- Live in an area where Medicare Advantage plans are sold
- Be a U.S. citizen or permanent resident
- Not have end-stage renal disease — although SNPs may still be an option
- Not be enrolled in Medigap insurance
When Is the Medicare Advantage Open Enrollment Period?
The open enrollment period for a Medicare Advantage plan is October 15 through December 7 each year. It’s important to note that this period is specifically for people who are already enrolled in Medicare. When you become eligible, you can sign up for Parts A and B during the initial enrollment period, or you can do this during general enrollment at the beginning of each year. Some people are also eligible for a special enrollment period if certain life events happen.
The changes you make to your Medicare coverage during the open enrollment period from October 15 through December 7 of each year will become effective on January 1. You don’t have to make any changes to your plan if it still meets your needs.
If you don’t make any changes, you’ll have to keep the coverage you currently have. You likely won’t be able to change again until the open enrollment period the following year. People who haven’t fully checked out their coverage options and found the best option for their needs might quickly realize that not changing to another plan is very costly.
What Can You Change During Open Enrollment for Medicare Advantage Plans?
There are several changes you can make during the open enrollment period. Be sure to consider your current medical conditions and Medicare needs so you can compare them to the available plans. Remember, this is a time when you can change Part C and Part D of your coverage.
- You can drop Part C and Part D coverage to return to only the original Medicare that encompasses Part A and Part B.
- You can add or drop a Part D plan from your Medicare coverage.
- You can change from Original Medicare to Medicare Advantage.
- You can switch to a new Part D option.