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Medicare Advantage Coverage and Enrollment Periods

Medicare Advantage is a cost-saving option for many seniors to cover out-of-pocket expenses associated with Medicare. These plans include many additional benefits that Medicare does not. Putting together similar coverage using Part A and B would require adding a Part D plan to be comparable.

Insurance Companies

With Part C Plans, individuals receive Part A and B coverage from an insurance company, not Medicare. In exchange, the government makes payments to them to cover the cost. Insurance companies negotiate with local hospitals and doctors for reduced rates. Unlike Medicare, you will be required to use this specific network of providers with these plans.

Coverage

Individuals continue to receive Medicare Part A and B coverage, as well as additional benefits not provided by Medicare. Most plans include benefits for prescriptions, dental, vision, fitness programs, and even hearing. Plans use a network of providers, and as a member, you agree to use the hospitals, doctors, and pharmacies in the service area. You can use providers who are not, but it will cost you more. It’s important to review your plan’s network requirements, If you don’t, you may be responsible for the total costs of services.

Cost of Plans

There are several different Medicare Advantage Plans to choose from, with varying premium amounts. Many companies offer $0 premium plans with additional benefits. Plans with no premium may be a cost-effective option, but they do have expenses like deductibles, and copays. The co-payment is in place of the 20 percent coinsurance you would pay under Medicare. Plans are required by law to put a maximum amount you will spend out-of-pocket for deductibles and copays each year.

Factors To Consider

Does the plan pay the Part B premium?

Does the plan provide extra benefits (prescription, vision, dental)?

What is the yearly deductible amount?

What is the cost for each doctor visit (copayment, coinsurance)?

What are the requirements and costs of network providers and out-of-network?

What is the out-of-pocket maximum?

Enrollment

You can enroll in Part C (Medicare Advantage plan) during specific times of the year. Enrollment periods were created to make it easy to get the coverage you need. However, outside of these dates, Medicare often requires that you stay with the plan you have until the following year. There are exceptions and in some cases, you may enroll outside of designated periods.

Initial Enrollment

The best time to enroll is during your Initial Enrollment period, or when you are first eligible to receive Medicare. Every senior in IL has an Initial Enrollment period that begins 3 months before you turn 65 and ends three months after. If you are disabled, your Initial Enrollment period begins 3 months before your 25th month of benefits and ends 3 months after your 25th month of benefits.

Annual Enrollment

Once you join Medicare, you can enroll in a Medicare Advantage plan during Annual Enrollment, October 15 through December 7 of each year. During this time, you can enroll, change, or drop a plan. If you miss the December 7 deadline, you may have to wait until the following year unless you qualify for a Special Enrollment.

Open Enrollment

If you are not satisfied with your plan, January 1st to March 31st is the time to make changes. You can change from Part C back to Medicare, or change a Part C plan to a different one. All changes take effect the following month.

Special Enrollment

Medicare realizes that some situations make it difficult to meet the enrollment periods. A Special enrollment was created to provide all seniors with the same opportunity.

 

 

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References:

Medicare Advantage Stats: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/

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