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Medicare Advantage (Part C)

Medicare Advantage plans provide Medicare coverage through private health insurance companies approved to participate in the Medicare program. 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 insurance premium. You might also have to pay a separate monthly insurance premium for your Medicare Advantage plan.

Deductibles

Some plans have deductibles.

Copays

A copayment 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 and Considerations

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 your health insurance plan’s Medicare Advantage 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.

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.

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When to Enroll
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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.
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Individuals Aged 65 or Older
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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.

Enrollment Period

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

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Individuals Aged Under 65 with an Eligible Disability
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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.

Monthly Benefits

Example: If you 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.

As of January 2019, a Medicare Advantage Open Enrollment Period is available from January 1 – March 31 every year. If you are enrolled in a Medicare Advantage plan, you will have a one-time opportunity to make changes to your Medicare coverage, which includes switching to a different Medicare Advantage plan OR returning to Original Medicare with the option to sign up for a Prescription Drug Coverage plan. This open enrollment period previously ran until February 15, but was extended by Congress to run until March 31 for those already enrolled in Medicare Advantage.


Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.

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2019 Coverage Options Download File