Medicare Advantage - Part C
Medicare Advantage plans (Part C) are health plans offered by private insurance companies that combine your Medicare Part A (hospital) and Part B (medical) into one plan. Many of these plans also include drug coverage (Part D), and those are called MAPD plans. But some Medicare Advantage plans do not include drug coverage, and those are called MA-only plans. It’s important to know which kind you are choosing so you don’t end up without the medicine coverage you need.
How Medicare Advantage Plans Work
Coverage: You pay co-payments or co-insurance when you see doctors, hospitals, or get services.
Price: You must still pay your Part B premium, plus the cost of the Medicare Advantage plan. Many plans have low or even no extra monthly premium.
Network: You use the contracted doctors and hospitals in the plan’s network. Most plans are HMO (must use network providers) or PPO (can use out-of-network at higher cost).
Medicare Advantage Eligibility
You must be enrolled in both Medicare Part A and Part B.
You must live in the plan’s service area (the county or state where the plan is offered).
You can only join or change a plan during the proper enrollment periods (like Initial Enrollment, Annual Enrollment, Medicare Advantage Open Enrollment Period, or a Special Enrollment).
You cannot have both Medicare Advantage and a Medicare Supplement (Medigap) at the same time.
Medicare Advantage Enrollment Periods
Initial Enrollment Period (IEP):
This is your first chance to sign up for Medicare. It lasts 7 months—3 months before your 65th birthday, your birthday month, and 3 months after. You can join a Medicare Advantage plan during this time if you have both Part A and Part B.Annual Enrollment Period (AEP):
This happens every year from October 15 to December 7. During this time, you can join, change, or drop a Medicare Advantage plan. Changes start on January 1.Medicare Advantage Open Enrollment Period (MA OEP):
This runs every year from January 1 to March 31. If you already have a Medicare Advantage plan, you can switch to a different one or go back to Original Medicare and add a Part D drug plan. You can only make one change during this time.Special Enrollment Periods (SEPs):
These are extra times you can join or change a plan if certain things happen, like moving to a new area, losing other coverage, or if your plan leaves Medicare.
Unless you are retiring with employer coverage, you have two main choices for Medicare: a Medicare Supplement plus a Drug Plan or a Medicare Advantage Plan.