Part C, also known as Medicare Advantage (MA) is a health insurance plan in the United States from a private health insurance company that provides Medicare benefits. The plan’s beneficiary pays a monthly premium to the government but will receive coverage from a private insurance company. Medicare Advantage plans cover Medicare Part A and Part B; some of these plans offer coverage for Part D, a prescription drug plan. Most Medicare Advantage plans are network-based. Medicare Advantage plans include a yearly provider out-of-pocket limit to spend.
This program was designed to give Medicare beneficiaries a low premium option other than Medicare and a Medicare Supplement. With minimal Medicare underwriting, these are an excellent option for those who missed their open enrollment period and cannot qualify for Original Medicare because of health conditions.
Medicare Advantage Rules
You must be enrolled in Medicare Part A and Part B to have a Medicare Advantage plan.
Medicare Advantage plans may have PPO or HMO networks. With a PPO network seeing a doctor outside of the network will result in higher costs to you. With an HMO plan, anything out of network except emergencies will not be covered.
With an Advantage plan, prior authorization may be required for specific procedures.
You may need a referral from your primary care physician to see a specialist with many HMO plans.
Medicare Advantage Enrollment Periods
Medicare Advantage plans have periods you can enroll, change, or disenroll from a plan.
– You can enroll during your Initial Enrollment Period when you turn 65.
– Once enrolled in a Medicare Advantage plan, you must stay in that plan for the remainder of the calendar year.
– You can only disenroll from a Medicare Advantage plan during specific times of the year unless you qualify for a Special Enrollment Period from a particular circumstance.
– The Open Enrollment Period also referred to as the Annual Enrollment Period (AEP) begins October 15th and ends December 7th. You can make any changes to a Medicare Advantage plan during this time.
– The Medicare Advantage Open Enrollment Period begins January 1st and ends March 31st. You can make any changes to a Medicare Advantage plan only once during this time.
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