Medicare Advantage

When you get your Medicare coverage, you might choose to participate in the Medicare program through a Medicare Advantage Plan (Medicare Part C) and/or Medicare Prescription Prug Plan (Medicare Part D). Most Medicare Advantage plans have integrated Part D coverage included in the plan. You could also choose other private health coverage that is not part of the Medicare program called a Medicare Supplement plan (Medigap).

Medicare has marketing rules for plans sold in the Medicare Advantage program which includes standalone prescription drug plans. After your initial enrollment period, you are locked into your plan until the next annual election period between October 15-December 7 every year. You can make as many changes as you like during this period to make sure you get the plan you want. Coverage in the new plan or renewal with the same plan that are part of the Medicare program will be effective January 1 of the following year. You may qualify for a Special Election Period (SEP) if you involuntarily lose your coverage during the enrollment period.

Aside from your Initial Election Period which includes the 7 months bracketing your birthday month and the Annual Election Period. These plans are annual contracts that insurers have with Medicare to replace Medicare during the enrollment period between January 1 and December 31. Plans are pretty likely to change on an annual basis, especially as regards to prescription drugs. If your costs are mostly drug driven then an annual review with me is undoubtedly a good idea, especially if you have never had a review. It doesn't cost you anything for a review with this office or to get my help understanding or enrolling in plans.

If you are newly eligible for Medicare because you turned 65, you can use your Initial Enrollment Period (IEP/ICEP) toenroll in a Medicare plan during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. All plans must accept you without asking health questions, ecxept in the case of end stage renal disease, because there is a special program for people that have been diagnosed or being treated for ESRD. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.

If you are newly eligible for Medicare because you have a disability (under 65) you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. In some states you might be able to sign up for a Medicare Supplement plan instead of Medicare Advantage. For people getting Social Security Disability, your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board (RRB) disability benefits. You can enroll during the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.

• You want coverage for what Medicare doesn't cover but you want to save as much money as you can for as long as you can.
• Medicare Advantage plans typically cost less per month than a Medigap plan (Original Medicare with a supplement) so they don't commit you to spending as much as you would for a supplement.
• If you add up all of your projected costs for the next ten years including the cost to purchase insurance you could see costs ranging between $0 for Medicare Advantage and $20,000 and more to purchase the insurance for a supplement even if you never use it.
• Medicare Advantage plans are cheap to buy but could be considerably more expensive by the end of the year because they generally have high out of pocket maximums that you may be responsible to pay. I recommend you do the math taken over a ten year period for the total annual cost of both insurance and out of pocket expenses to see which would be a better fit. Supplements are normally health underwritten except during the first six months after you initially receive your Part B coverage which is your Medicare open enrollment period and certain guaranteed periods mostly related to involuntary loss of insurance.
• Medicare Advantage Plans may cover costs & services not covered by Original Medicare and could also include or offer dental and vision coverage as a buy up.
• Medicare Advantage Plans may have no deductibles & lower co-payments than Original Medicare.
• Most Medicare Advantage Plans have very low premiums. Plans with premiums as low as $0 a month may be available in your area, however, the plans aren't free. Medicare pays the monthly average Medicare reimbursement rate for the county you live in to the insurer for each beneficiary they enroll, plus supplemental payments for high morbidity and delivering high quality plans as denoted by Medicare's star rating system.
• The primary advantage is that they usually cap your out of pocket expenses, unlike regular Medicare which has no out of pocket limit.

• There are different types of Medicare Advantage plans: PPO, HMO, or PFFS. PPO plans allow you to see any doctor but you will pay more to see a doctor out-of-network, and they often have smaller lists of doctors in-network.
  Private-Fee-For-Service (PFFS) Plans with no network restrictions are available -- see any health provider that accepts Medicare and accepts the plans terms and conditions of payment.

• No health questions asked. All Medicare beneficiaries, including people on Medicare due to a disability, are guaranteed acceptance regardless of health conditions (except End Stage Renal Disease). "Special Needs Plans" with lower or no out-of-pocket costs may be available for you as a "Dual Eligible" -- people enrolled in both Medicare & Medicaid or if you have certain chronic illnesses.

• Check your red, white, and blue Medicare card.
• Your old Medicare number with your or your spouse's Social Security has been replaced. If you are still using your old number, either call Social Security or go to https://ssa.gov and get a replacement Medicare card.
• Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
• Check your Medicare health or drug plan enrollment.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
• Call your insurance broker