MEDICARE ADVANTAGE  PLAN

Medicare Advantage Eligibility

If you’re eligible for Medicare, you can also qualify for a Medicare Advantage (Part C) plan. To enroll, you must first be signed up for both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). It’s important to keep Part B active because dropping it will result in losing your Medicare Advantage plan.

Basic Eligibility Requirements:

• Enrollment in Original Medicare (Parts A and B): You must be enrolled in both parts before considering a Medicare Advantage plan.
• Location Requirement: You need to live in the service area of the Medicare Advantage plan you want to join.
• Citizenship: You must be a U.S. citizen or a permanent resident who has lived in the U.S. for at least five consecutive years.
• End-Stage Renal Disease (ESRD): Since 2021, individuals with ESRD are eligible to enroll in most Medicare Advantage plans, a change from previous rules that often excluded them.

Medicare Advantage Enrollment Periods

Knowing when you can enroll in a Medicare Advantage plan is crucial. Here are the main enrollment periods:

1. Initial Enrollment Period (IEP):
   • A 7-month window that starts three months before your 65th birthday, includes your birthday month, and extends three months afterward.
   • If you qualify for Medicare before age 65 due to disability, your enrollment period begins three months before your 25th month of receiving Social Security benefits.
2. Annual Enrollment Period (AEP):
   • Dates: October 15 to December 7
   • During AEP, you can switch from Original Medicare to a Medicare Advantage plan, change your current Medicare Advantage plan, or return to Original Medicare. Coverage begins on January 1 of the following year.
3. Medicare Advantage Open Enrollment Period:
   • Dates: January 1 to March 31
   • This period allows current Medicare Advantage enrollees to switch to a different Medicare Advantage plan or revert to Original Medicare.
4. Special Enrollment Periods (SEPs):
   • These are triggered by specific life events, such as moving out of your plan’s service area, losing employer coverage, or qualifying for extra help with prescription drug costs. Consult a licensed Medicare agent to determine your eligibility for SEPs.

Medicare Advantage Coverage and Costs

Medicare Advantage plans must cover all services provided by Original Medicare (Parts A and B), but many also offer extra benefits like:

• Vision, hearing, and dental care
• Wellness programs (e.g., gym memberships)
• Prescription drug coverage (similar to Medicare Part D)

Cost Factors for Medicare Advantage Plans:

• Premiums: Some plans have a $0 monthly premium, but you will still need to pay your Part B premium.
• Deductibles: Plans may have a deductible for medical services and a separate one for prescription drugs.
• Copayments and Coinsurance: These are out-of-pocket costs for doctor visits, prescriptions, and other services.
• Out-of-Pocket Maximum: Medicare Advantage plans have an annual limit on your out-of-pocket expenses, offering financial protection if you face high medical costs.

Annual Enrollment Period (AEP) Quick Facts:

• Dates: October 15 – December 7
• Actions You Can Take: Enroll in a new Medicare Advantage plan, switch plans, or return to Original Medicare.

Why Choose Medicare Advantage?

Medicare Advantage plans offer a more comprehensive approach to healthcare coverage by bundling additional services not typically included in Original Medicare. If you prefer having one plan to cover all your needs, including prescriptions, dental, and vision, a Medicare Advantage plan might be the right choice for you.