Medicare Advantage, also known as Part C, is offered by private companies approved by Medicare to handle your Part A and Part B hospital and medical coverage. Most plans have additional benefits such as prescription drug coverage and coverage for dental, vision, and hearing care.
Qualifying
To enroll in a Medicare Advantage plan, you first need to be enrolled in Original Medicare. You also need to be living in the plan’s coverage area. Those with End-Stage Renal Disease (ESRD) may not qualify for a general Part C plan, but there are Special Needs Plans available for those with certain chronic conditions.
Finding a Plan
Medicare Advantage plans come in a few flavors. There are HMOs, PPOs, PFFS plans, and SNPs. Health Management Organization (HMO) plans require the insured to have a primary care physician and require referrals to see a specialist. Preferred-Provider Organization (PPO) plans are more flexible, with no referrals to see a specialist and no primary care physician required. HMOs and PPOs have networks and seeing a provider outside the network will cost more. Private-Fee-for-Service (PFFS) plans allow you to see any provider that accepts your plan’s terms. Special Needs Plans (SNPs) restrict their membership to those who have certain chronic conditions and operate with a network of specialists for those conditions.
Enrolling
There are two enrollment periods relevant to Medicare Advantage plans. If you have Original Medicare and want to switch to a Medicare Advantage plan, you can do so during the Annual Election Period (also called the Open Enrollment Period). This falls from October 15 to December 7 of each year. As long as you live in the plan’s coverage area, are already enrolled in Medicare, and do not have ESRD, you can switch from Original Medicare to a Medicare Advantage plan.
From January 1 to March 31 every year is the Medicare Advantage Open Enrollment Period. If you already have a Medicare Advantage plan and are looking to switch to a different plan, you can do so at this time. You can also choose to switch back to Original Medicare and add a prescription drug plan to maintain a similar level of coverage.
