Medicare Part C (Advantage Plan)
Medicare Advantage Plans are private health insurance plans that offer an “all in one” alternative to Original Medicare. These bundled plans include Part A, Part B and usually prescription drug coverage (Part D). Plans have specific networks in place, which may limit doctors and hospitals available to you. It may also be difficult to find skilled nursing homes in plan network. Plans may also offer extra benefits that Original Medicare does not cover, like vision, hearing and dental.
Medicare Advantage Plans typically have lower monthly premiums but higher out-of-pocket costs for Medicare-approved expenses. It is important that you take time to review plans carefully to know what copays, networks and limits apply to benefits offered.
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 use a specialist or whether you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). Costs may increase if you use out-of-network doctors or facilities.
The Medicare Open Enrollment period runs October 15 to December 7 each year. Plans are allowed to change their cost and coverage rules from year to year. It is important to read the Annual Notice of Change received each year to see if there are any changes that may affect you. Medicare beneficiaries may compare plans and make changes in their Medicare Advantage Plan or Medicare Part D (drug) plan during this open enrollment period. Those changes will take effect on January 1.
Plan changes may affect your monthly premium, deductible, out of pocket maximum, drug co-pays and your pharmacy, doctor or hospital choices. It is important that you review your plan options each year during open enrollment.
The Medicare Advantage Open Enrollment period runs from January 1 to March 31 each year for individuals who already have a Medicare Advantage Plan. During this enrollment period, you can switch to another Medicare Advantage Plan or drop your Medicare Advantage Plan and return to Original Medicare. You can also join a separate Medicare Drug Plan.
During the Medicare Advantage Open Enrollment period, if you have Original Medicare, you cannot switch to a Medicare Advantage Plan, join a Medicare drug plan or switch from one Medicare drug plan to another.
You can only make one change during the Medicare Advantage Open Enrollment period. Any change you make will be effective the first of the month after the plan gets your request. If you’re returning to Original Medicare and joining a separate Medicare drug plan, you do not need to contact your Medicare Advantage Plan to disenroll. The disenrollment will happen automatically when you join the drug plan.