Medicare Advantage (Part C)
Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans offered by private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In many 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. In many cases, you may need to get approval, also called prior authorization, from your plan before it covers certain drugs or services.
If you join a Medicare Advantage Plan, you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
You must use your Medicare Advantage Plan card to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you may need to show your Medicare card for some services. Also, you’ll need it if you ever switch back to Original Medicare.
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 Medicare Initial Enrollment Period when you turn 65.
- Medicare Open Enrollment Period also known as Annual Enrollment Period (AEP). AEP runs from October 15th through December 7th.
- Medicare Advantage Open Enrollment Period runs from January 1st through March 31st.
- Medicare General Enrollment Period runs from January 1st through March 31st.
- Medicare Special Enrollment Periods are for a particular circumstance.
