Medicare Part C is also referred to as Medicare Advantage or MA for short. Private insurance companies offer these plans that the federal government has authorized to issue policies.
Medicare Advantage plans combine the coverage of Parts A and B and also add in extra benefits like dental, vision, and hearing coverage, housekeeping services, caregiver counseling and training, and prescription drug coverage.
None of those services are covered by Original Medicare.
Some Part C plans have no premiums since Medicare pays the insurance carrier to provide coverage.
Medicare Advantage Eligibility
All Medicare beneficiaries enrolled in Medicare Part A, and Part B are eligible to enroll in Medicare Part C.
The only exception is those with End-Stage Renal Disease. These individuals are not eligible for a Part C plan.
Enrolling in Medicare Advantage
Medicare Advantage has specific enrollment periods.
Initial Election Period
Each individual has their Initial Election Period. This period begins three months prior to your 65th birthday and extends three months after your 65th birthday, for a total period of seven months.
If you are receiving disability benefits from Social Security, you are eligible for Medicare after receiving disability benefits for 24 months. You may apply for an MA plan three months prior to your eligibility date (which would begin on the 25th month of your disability benefits). This enrollment period extends to three months after your eligibility date.
Special Election Period
To qualify for a Special Election Period, you must meet specific requirements. The most common way individuals qualify is if they postpone enrollment into Original Medicare because they have other creditable insurance coverage. Once the individual enrolls in Original Medicare, they are also eligible to enroll in Medicare Advantage.
Other qualifying events include moving outside your plan’s coverage area, your plan getting terminated for reasons outside of your control, or you qualify for Extra Help.
To find out if you qualify for a Special Election Period, give Senior Benefit Solutions a call!
Annual Election Period
The Annual Election Period (AEP) occurs each fall from October 15 through December 7. During this time, you can choose to change or drop your current Part C plan. Your new coverage will begin on January 1.
Medicare Advantage Open Enrollment Period
This is often confused with AEP. However, there are other things you can do during the Open Enrollment Period, which runs from January 1 through March 31 each year.
During Open Enrollment, you may disenroll in your current MA plan and switch back to Original Medicare. The opposite is also true – you may change from Original Medicare to Medicare Advantage.
You may also switch MA plans, disenroll from your Part D prescription drug plan, and switch from your current Part D plan to another Part D plan.
Medicare Advantage Benefits
Because Medicare Advantage plans bundle benefits from Medicare Parts A and B, they must offer the same benefits provided by Parts A and B. This coverage applies to inpatient and outpatient care, skilled nursing facility care, diagnostic tests, surgeries, home health care, durable medical equipment (DME), and preventive services.
Medicare Advantage plans include additional benefits not seen in Original Medicare. Some of these services are:
- dental care
- hearing exams
- hearing aids
- vision exams
- glasses or contact lenses
- gym memberships
- wellness and nutrition programs
- over-the-counter drugs
- prescription drugs
- adult daycare
- transportation to doctor visits
- services for chronic conditions