In Medicare Advantage (MA) plans, you receive all the benefits of Medicare Parts A and B through a private company contracting with Medicare. The options and plan limitations may confuse first-time enrollees, who may be eligible for Original Medicare but may not be familiar with Medicare Advantage.
Time restrictions and special requirements for joining most plans create an urgency, as late enrollment can result in a gap in coverage or a penalty rate. Therefore, understanding the Medicare Advantage enrollment process with The Big 65 is essential if you plan to enroll in one.
Enrolling In Medicare Advantage With The Big 65
Like any insurance product, private insurance carriers sell these plans, and enrollment is similar to buying a health policy. You can enroll in a Medicare Advantage plan directly from a private company. This is very effective if you know which company and plan you are interested in. Medicare Advantage with The Big 65 options available in your area can be compared with the help of an insurance broker.
You may have to provide details about your address to find a program that can meet your needs. Your insurance broker will ask about your specific insurance needs and prescriptions that you are taking. Information collected here is only used to assist you in finding a plan that fits your needs.
When To Join Medicare Advantage Plans
1. The Initial Coverage Election Period (ICEP)
Medicare Advantage plans are usually purchased during the initial coverage election period (ICEP). In a nutshell, for the ICEP, you have a seven-month window starting from the month you turn 65 and are eligible to receive select Medicare benefits. The Initial Coverage Election Period begins three months prior to your 65th birth month and three months after your 65th birthday month. While signing up outside of this period is not subject to a penalty, signing up as early as possible is highly recommended.
Medicare plans usually take three months to take effect, so enrolling after your birthday may result in a little gap in your medication coverage. This gap could last up to three months. If you switch from the pre-Medicare range to Medicare, the gap may last up to three months. Therefore, It is essential to begin your research before the ICEP to submit the forms on time. However, Part D drug plans begin on the first day of your birth month of turning 65.
2. Medicare Advantage Annual Election Period
Newly eligible Medicare beneficiaries often choose Original Medicare at first, then switch to Medicare Advantage later. Every year from October 15th to December 7th is the Annual Election period. You can make changes during this time without facing a penalty.
3. Medicare Advantage Special Enrollment Period
Medicare Advantage enrollment may occur outside of the normal enrollment period when circumstances dictate. These circumstances fall under the Special Election Period (SEP).
An out-of-period registration can be tricky, but you may justify it under certain circumstances. An example of an exceptional circumstance is moving from one coverage area to another. This might require you to switch providers.
Understanding Medicare’s Basics
Understanding Original Medicare and its various parts are helpful before enrolling in Medicare Advantage. It is divided into several pieces that cover different types of medical care:
1. Part A Medicare
The Medicare Part A plan provides basic coverage to Medicare beneficiaries. Seniors who qualify are eligible to receive inpatient hospitalization coverage under this plan once the deductible is paid.
Part A coverage is automatically available to all U.S. citizens after they become eligible, with no out-of-pocket expenses or monthly premiums.It also covers spouses who are not US citizens if they had paid into the Social Security system for at least 10 years. Part A generally covers hospital admissions and treatments provided within the scope of inpatient care.
Services are billed directly to Original Medicare and paid according to an agreed-upon schedule. Providers in the Part A network will charge a one-time Medicare deductible for patient services.
2. Part B Medicare
Outpatient services are covered under Medicare Part B, just like inpatient services are covered under Medicare Part A. This includes some special care and doctor’s office visits.
Medicare enrollees need to in Part A and Part B. When you enroll in Part B, you’ll be charged a monthly premium, depending on your income. This is essential for your coverage to become activated and ready to use. Another option would be to remain on an employer based Creditable Coverage plan and defer Part B until retirement, and then use an SEP of LEP (Loss of Employer Coverage).
3. Part C Medicare
Original Medicare does not include Part C, which refers to private insurance that seniors can buy on the open market. Medicare Part C plans, also called Medicare Advantage Plans (MAPD), are required to have benefits at least as good as Original Medicare Part A and B, but may also include extra benefits not available under Original Medicare. Transportation costs, eyeglasses, and durable medical appliances are additional coverage. Prescription drug benefits are included in some Part C plans.
Medicare Advantage plans are available through approved providers in every state. As part of Medicare Part C, Medicare Advantage plans cover hospitalizations, office visits, prescription drugs, and may include additional benefits seniors need, such as eye exams and physical therapy. Depending on the private insurance market, prices and coverage limits can vary greatly, and you should research every plan thoroughly before you purchase it.
4. Part D Medicare
The Medicare Part D plans are based on the county you live in and pricing is pretty much uniform across the board in a given area. For example, plan prices may be more expensive in metropolitan areas versus rural areas.
Medicare Supplement Plans (Medigap Policies) & Medicare Advantage Plans
You must not have a Medicare Advantage plan and a Medigap plan at the same time. If you are a Medigap policyholder and you enroll in a Medicare Advantage Plan (Part C), you must disenroll from the Medigap policy. You will not automatically be disenrolled. Your Medigap policy cannot cover copayments, deductibles, and premiums associated with your Medicare Advantage Plan.
However, first-time enrollees in Medicare Advantage Plans have a “trial right” under federal law to buy Medigap coverage if they’re unhappy with their plan.
Summary
Both Medicare Advantage Plans and Medigap Plans offer consumers robust coverage options. Before applying for any Medicare Advantage plan, do your research. Find an independent Medicare Insurance broker to help you navigate the enrollment period. Be sure to also visit the official Medicare Plan Finder site to see if you qualify and to learn more about plans that are available to you.
