Medicare Advantage plans provide Medicare coverage through government-approved private health insurance companies. These plans can be HMOs, PPOs, Regional PPOs or Private Fee-for-Service plans.

Medicare Advantage plans provide all Part A and B services while generally including some additional services, such as wellness programs, hearing aids and vision services. These plans also tend to have lower cost sharing overall and a maximum that you would have to pay for out-of-pocket costs each calendar year–a feature not available through Original Medicare.

Costs

Premium All Medicare Advantage plans require that you continue to pay your Part B premium. You might also have to pay a separate monthly premium for your Medicare Advantage plan.
Deductible Some plans have deductibles.
Copays A copay may apply to specific services, such as doctor office visits.
Coinsurance

Cost sharing amounts may apply to specific services.

Out-of-Pocket Expenses

All Medicare Advantage plans have an annual limit on your out-of-pocket expenses, which is a feature not available through Original Medicare.

Limits

Medicare Advantage plans have defined geographic service areas and most have networks of physicians and hospitals where you can receive care. Ask your physicians if they participate in a Medicare Advantage plan’s network.

Things to Consider

  • Medicare Advantage plans (such as PPO and HMO plans) generally include prescription drug coverage.
  • Your annual costs may vary depending on the premiums, copayments, coinsurance and benefits of the plan you select.
  • Medicare Advantage plans may have copayments or cost sharing amounts on Medicare covered services that differ from the cost sharing amounts in Original Medicare.
  • Medicare Advantage plans may change their monthly premiums and benefits each year. This also occurs in Original Medicare, as Part B premiums, standard deductibles and cost sharing amounts generally change annually on January 1.

Enrollment

Learn more about Medicare Advantage (Part C) enrollment.


Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B, you can select other coverage options like a Medicare Advantage plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.

When to Enroll

When you are first eligible, your Initial Enrollment Period for Medicare Part A and Part B lasts seven months and starts when you qualify for Medicare, either based on your age or an eligible disability.

Individuals Aged 65 or Older

Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are born on June 18, 1952, your Initial Enrollment Period is from March 1, 2017 until September 30, 2017.

Individuals Aged Under 65 with an Eligible Disability

Your Initial Enrollment Period is based on when you began receiving Social Security or Railroad Retirement Board (RRB) disability benefits. It begins the 22nd month after you began receiving benefits and continues until the 28th month after you began receiving benefits.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are began receiving disability benefits in January 2015, your Initial Enrollment Period is from November 1, 2016 until May 31, 2017.

How to Enroll

You must first enroll in Medicare Part A and Part B before joining a Medicare Advantage plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Advantage plan and getting enrolled.

Open Enrollment Period

October 15 through December 7

The Medicare Open Enrollment Period provides an annual opportunity to review, and if necessary, change your Medicare coverage options.  Coverage becomes effective on January 1. During Open Enrollment, some examples of changes that you can make include:

  • Join a Medicare Advantage (Part C) plan.
  • Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
  • Change from one Medicare Advantage plan to another.
  • Add or Change your Prescription Drug Coverage (Part D) plan if you are in Original Medicare.

Medicare overview information on this website was developed by the Blue Cross and Blue Shield Association to help consumers understand certain aspects about Medicare. Viewing this Medicare overview does not require you to enroll in any Blue Cross Blue Shield plans. To find out about premiums and terms for these and other insurance options, how to apply for coverage, and for much more information, contact your local Blue Cross Blue Shield company. Each Blue Cross Blue Shield company is responsible for the information that it provides. For more information about Medicare including a complete listing of plans available in your service area, please contact the Medicare program at 1-800-MEDICARE (TTY users should call 1-877-486-2048) or visit www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.