Medicare Part C - Medicare Advantage Plans

Overview

Medicare Advantage, or Medicare Part C, is a program that offers other health plan options that pay for original Medicare-covered services (Parts A and B) plus additional benefits and services through private health insurers such as:

• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Private fee for service (PFFS) plans
• Special needs plans (SNPs)

How Medicare Advantage Plans Work

• The funds paid by the federal government to these private health insurers are used to pay the doctors, specialists and hospitals that you use; however, the care is managed by the private health insurers.
• The private health insurers may also offer supplemental benefits not covered by original Medicare such as vision, hearing, chiropractic care and more.
• Plan members usually are directed toward a network of doctors, hospitals and other health care professionals to receive services, but are not required to use those professionals.

Medicare Advantage Plans - Costs

• In a Medicare Advantage plan, you may pay a monthly premium as well as copayments - which are usually a fixed amount - when you receive services.
• The Medicare Advantage premium includes coverage for Medicare Part A and Medicare Part B benefits, prescription drug coverage (if offered) and any other benefits allowed by the plan.
• You will also continue to pay your Medicare Part B premium while enrolled in Medicare Advantage.

Medicare Advantage Plans - Drug Coverage

• Health insurers offering Medicare Advantage plans generally must provide at least one plan with basic prescription drug coverage, but most offer multiple options.
• If you choose a Medicare Advantage plan that offers prescription drug coverage, you must receive your benefits through that plan, rather than enrolling in a separate Medicare Part D plan.

Medicare Advantage Eligibility

• You are eligible for Medicare Advantage if you are entitled to Medicare Part A and enrolled in Medicare Part B.
• If you choose a Medicare Part C plan, your coverage becomes effective the same date as your Medicare coverage.

Medicare Part C Enrollment

There are four periods during which you may enroll in Medicare Part C:

Initial Enrollment Period

• This is a seven (7) month enrollment period for those who are newly eligible for Medicare as a result of turning 65.
• The seven month period consists of the three months before, the month of, and the three months after your 65th birthday.
• If you choose not to enroll during your initial enrollment period, you may be subject to a late enrollment penalty

Annual Enrollment Period

• Between November 15 and December 31 of each year, anyone eligible for Medicare Advantage coverage may either switch plans or enroll in a plan.

Open Enrollment Period

The open enrollment period from January 1 through March 31 of each year can be used only for certain Medicare Advantage enrollment situations. These situations are for:

1. Medicare Advantage members who may enroll in:

• A different Medicare Advantage plan, or
• Original Medicare only

2. Medicare Advantage plan with prescription drug members who may enroll in:

• A different Medicare Advantage plan with prescription drugs, or
• Original Medicare and a prescription drug plan

3. Original Medicare* (Parts A and B) beneficiaries with no other coverage who may enroll in a Medicare Advantage plan

* Beneficiaries with original Medicare may also be enrolled in a Medigap plan.

Special Enrollment Period

• There are several special circumstances that would allow a Medicare-eligible recipient to enroll in a Medicare Advantage plan outside of the initial or annual enrollment periods.
• Some examples include, but are not limited to:
  • Moving into the service area
  • Involuntarily losing creditable coverage
  • Becoming dual eligible (qualified to receive more than one state or federal subsidy)

Blue Cross and Blue Shield of Texas is not connected with or endorsed by the US Government, the Federal Medicare Program or any other governmental agency.