Medicare Advantage

While there are many options for those eligible for Medicare benefits, one of the most popular products available is Medicare Advantage. Medicare Advantage is an all-in-one Medicare plan sold by private insurance companies. Medicare Advantage replaces your Original Medicare Part A and Part B benefits. This is different from Medicare Supplement Plans that work with and supplement Original Medicare. Medicare Advantage plans must at least offer the same benefits as Original Medicare Part A and Part B. However, most Medicare Advantage plans provide additional supplemental benefits. Supplemental benefits include things like lower cost-sharing, over-the-counter health care products, dental, vision, hearing, fitness memberships, transportation, meal plans, and more. Most Medicare Advantage plans also include Medicare Part D prescription drug coverage and are commonly known as MAPD plans.

One significant advantage of Medicare Advantage plans is your health status or pre-existing conditions have no impact on your eligibility to enroll or on your premiums. Insurance companies offering Medicare Advantage plans cannot deny coverage or increase rates based on your health status as they can with Medicare Supplement policies. To enroll in Medicare Advantage, you only need to meet two eligibility conditions:

1. Be enrolled in Original Medicare both Parts A and B.
2. Reside in a county in which the insurance company offers the product you wish to enroll in.

There are several different enrollment periods for Medicare Advantage available under different situations.

Your Initial Enrollment Period (IEP) includes the three months before you turn 65, your birthday month, and the three months after your birthday month. During this time, you can:

• Enroll in Medicare (Parts A and B)
• Enroll in a Part-D drug plan
• Enroll in a Medicare Advantage plan (Part C)

The Annual Enrollment Period (AEP) is from October 15th through December 7th every year. All changes made during AEP are effective January 1st, the following year. During this time, you can do any of the following:

• If you’re enrolled in Original Medicare, you can enroll in a Medicare Advantage plan or vice versa.
• If you are enrolled in a Medicare Advantage plan with drug coverage (MAPD), you can switch to one without (MA Only) or vice versa.
• You can enroll in or drop a Part-D prescription drug plan
• You can change the Medicare Advantage plan you are enrolled in to another plan offered by your insurance company or switch to a plan provided by another insurance company.

The Open Enrollment Period (OEP) occurs from January 1st through March 31st. This enrollment period allows those enrolled in a Medicare Advantage plan to make one change to either another Medicare Advantage plan or Original Medicare. During OEP, you are only allowed to make one change which becomes effective the 1st of the month following the month the change is submitted. You cannot enroll in a stand-alone Part-D plan if you’re in Original Medicare or switch from one stand-alone Part-D plan to another if you’re in Original Medicare during OEP.

Special Enrollment Periods (SEP) are designed for special situations that happen outside IEP, AEP, or OEP and allow you to join, switch or drop a Medicare Advantage or Part-D drug plan. The length and changes permitted will vary depending on the type of SEP you qualify for. SEP’s include things like:

• Moving out of your plan’s service area
• Loss of employer-based coverage
• Natural disasters such as hurricanes
• and many other unique situations

Medicare Advantage out-of-pocket cost can vary from plan to plan based on the specific plan you enroll in and the health care services you use. Out-of-pocket costs include the following:

• Annual deductible (not all plans have deductibles)
• Co-payments
• Coinsurance
• Increased out-of-pocket costs if you go out of network with PPO or HMO-POS plans
• Part-D prescription drug costs (separate deductible, copays, and coinsurance than medical)

Out-of-pocket costs for Medicare Advantage plans are limited by your plan’s Maximum Out-Of-Pocket (MOOP) limit. If you are enrolled in a PPO, your plan will set two MOOPS’s, one for in-network costs and another for a combination of in-network and out-of-network costs. In 2021, the maximum allowable MOOP for Medicare Advantage Plans is $7,550, but plans are allowed to set lower limits.