Lesson 07: Medicare Part C (Advantage Plans)
Medicare Advantage Plans
Medicare Advantage Plans previously called Medicare + Choice, is a result of the 1997 Balanced Budget Act that, among other things, increased the number of health care options available to those who qualify. Companies that sponsor MA plans contract with the Centers for Medicare and Medicaid Services (CMS) if they choose to participate. All Medicare Advantage plans must offer at least the same basic benefits as original Medicare.
Eligibility
To enroll in a Medicare Advantage plan, a person must:
- Be enrolled in Medicare Parts A and B.
- Live within the plan`s service area.
- Not have End Stage Renal Disease (ESRD).
Note: Those who are diagnosed with ESRD after enrolling in a MA plan can remain in the plan.
Benefits
MA plans must offer, at the very least, the benefits that original Medicare offers. Premiums and co-insurance payments may differ, or a plan may offer additional benefits, but all plans must offer the basic benefits. Providers under contract with a managed care plan are generally required to accept the plan`s payment as payment in full.
Different Types of Medicare Advantage Plans
There are other less common types of Medicare Advantage Plans that may be available:
- HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
- Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
Enrollment and Disenrollment
Enrollment and disenrollment from Medicare Advantage is permitted only during Open Enrollment (November through March of the next year). Once enrolled, members must remain in the plan from April to December, except for special circumstances.
To Disenroll:
- Contact the plan or local Social Security office and complete a disenrollment form to return to Original Medicare. No disenrollment form is needed if switching from one Medicare Advantage plan to another. Disenrollment from the old plan is automatic when the new plan begins.
- Enrollment in the new Advantage plan and disenrollment from the old plan is automatic.
Help choosing a Medicare Advantage Plan