Back in the mid-90′s, people receiving Medicare were given the option to choose private health care plans to provide their Medicare coverage rather then having Medicare manage their benefits. In the next seven to eight years, this evolved into what we now know as the Medicare Advantage program. There are many approved health care plan providers and it’s best to research what is available in your area before deciding to enroll in the Medicare Advantage plan.
To understand how or why to enroll in Medicare Advantage, it is helpful to know what each Medicare plan is and what it offers:
- Medicare Part A (hospital insurance) – covers inpatient hospital care, or care in a nursing facility, hospice, and some home health care
- Medicare Part B (medical insurance) – covers regular doctors visits, outpatient care, some preventative services, and some home health care
- Medicare Part C (Medicare Advantage) – covers everything in part A & B, and may also cover such things as dental, vision, hearing, and wellness programs, and sometimes includes prescription coverage (part D)
- Medicare Part D (prescription drug coverage) – covers some or all of the cost of approved prescription medications
For a full description and details of these Medicare programs, the official government website for the Medicare program is www.medicare.gov.
Steps For Enrollment
Once a person reaches age 65 they are automatically eligible for Parts A & B as long they are receiving social security. Generally a few months before a person is eligible, they will be contacted with enrollment information. Because there can be a fee involved for part B, persons may turn that coverage down. A person can sign up for Part B in the three month period before or after their 65th birthday, which makes for a seven month window of enrollment. If a person misses the initial enrollment period, they can enroll during the first three months of each year for coverage that will start July 1st. There are fees and higher premiums involved if a person declines to sign up during the initial enrollment period then decides to enroll in a later year.
For Medicare Advantage, a person can choose that plan during the initial 7 month enrollment period for Medicare part B, on or around the 65th birthday. Every year a person can make changes to their Medicare Advantage plan.
There are important dates and conditions to understand in the enrollment and modification of coverage:
- October 15- December 7: open enrollment period – this is the time when one can switch to Medicare Advantage, switch back to regular Medicare, or change Medicare Advantage plans, coverage will begin January 1st
- January 1- February 15: drop period – during this time one can drop Medicare Advantage and switch back to regular Medicare only, this is not a regular enrollment period
There are other special circumstances that can allow for modification of coverage during different periods. For detailed information call 1-800-MEDICARE.
Co-Pays and Deductibles
When a person signs up for a Medicare Advantage Plan, they are still required to pay the fees and premiums for Medicare Part B as well as the Medicare Advantage Plan’s premium if it charges one.