Medical Benefits & Prescription Drug Coverage
Private insurance companies offer Medicare health plans, known as Medicare Advantage, that provide the standardized hospitalization and medical benefits on Medicare Part A and Part B. These plans are approved and regulated by Medicare. Some Medicare Advantage (MA) plans include additional benefits that are not part of Part A and Part B such as prescription drug coverage (MAPD). MA plans are required to deliver benefits at least as good as original Medicare Part A and Part B but the plan does not have to deliver these benefits in the same way. Some plans offer additional benefits to plan members beyond Part A and Part B. An example would be dental or vision benefits.
Medicare Advantage plans use one of the following options:
- HMO – Health Maintenance Organization: a network of health care providers and facilities where you choose a primary care physician to coordinate your care
- PPO – Preferred Provider Organization: also a network of health care providers and facilities but typically you do not need to select a primary care physician and you have more flexible options regarding out-of-network care
- PFFS – Private Fee For Service: most similar to Original Medicare, where you are not limited to a network but there are no guarantees that your doctor or hospital will accept the plan
Medicare Advantage plans typically cost less than Medicare Supplement plans but may cover different benefits. Recent legislative changes to healthcare in the U.S. may drive up Medicare Advantage monthly premiums so it is important to compare prices before enrolling. Some Medicare Advantage plans currently offer premiums as low as $0 per month. However, recent legislation changing the compensation rates, these $0 premium plans may disappear.
The Medicare Advantage program has become very popular. By 2009, there were an estimated 11 million enrollees. This number represents one out of four Medicare beneficiaries.
You must have both Medicare Part A and Part B to be eligible to enroll in Medicare Advantage plans. Eligible individuals may also need to wait to enroll during an approved enrollment period. After enrolling in Medicare Advantage, you are responsible for continuing payment of your Medicare Part B premium alongside the Medicare Advantage premium.
Call (800) 334-9330 for more information.
You can also use our Quick Quote Form to get started.
Medicare Advantage Disenrollment Period (MADP)
One Last Chance for Change!
January 1st through February 14th is the Medicare Advantage Disenrollment Period (MADP). During this enrollment period if you are currently in a Medicare Advantage plan you can leave your plan and switch to Original Medicare. Your Original Medicare coverage will begin on the first day of the following month. At this time, if you have switched to Original Medicare you will also have the opportunity to enroll into a stand-alone Prescription Drug Plan (PDP) until February 14th. Your prescription drug coverage will begin on the first day of the following month after the enrollment form has been received.
From January 1st through February 14th:
|If your situation is:||Your option is:|
|You are currently enrolled into Medicare Advantage plan with drugs (MAPD)||Revert to Original Medicare and you may enroll into a stand-alone Prescription Drug Plan (PDP) through a Special Election Period generally referred to as the Annual Disenrollment Period (ADP), should you chose to do so.|
|You are currently enrolled into A Medicare Advantage plan without drugs (MA)||Revert to Original Medicare and you may enroll into a stand-alone Medicare Prescription Drug Plan (PDP) through a Special Election Period generally referred to as the Annual Disenrollment Period (ADP), should you chose to do so.|
|You are currently enrolled into a Private Fee for Service Medicare Advantage Plan (PFFS)||Revert to Original Medicare and enroll into a different Medicare Prescription Drug plan if you prefer to do so through the MADP code or the ADP code.|
You have one opportunity to make a change to your Prescription Drug Plan (circumstances allowing) during the Medicare Advantage Disenrollment Period.
Please note that once you enroll into a stand-alone Medicare prescription drug plan during the MADP, you will be automatically disenrolled from your existing Advantage plan, with one exception. If you are currently enrolled into a Medicare Advantage Private Fee For Service Plan (PFFS) without drug coverage, you must call your existing plan to cancel.
Unless you are eligible for a Special Election Period due to certain circumstances, once you disenroll from your current Medicare Advantage Plan you will not have another opportunity to enroll into another Medicare Advantage Plan until the Annual Election period, which runs from October 15th through December 7th.
During the Medicare Advantage Disenrollment Period you cannot:
- Switch from Original Medicare into a Medicare Advantage Plan
- Switch from one Medicare Advantage plan to go into another Medicare Advantage Plan
- Switch from one Medicare Prescription Drug Plan to go into another Medicare Prescription Drug Plan
- Switch, join or drop a Medicare Savings Account Plan
If you disenroll from a Medicare Advantage Plan, federal law does not give you the right to purchase a Supplement (also known as Medigap). However state laws may give you more rights and allow you to apply for a Supplement. Check with your State Health Insurance Assistance Program (SHIP) to verify enrollment eligibility. You can also call 1-800-MEDICARE.
Keep in mind that the MADP does not qualify you for guarantee issue by a Supplement carrier. You may or may not be subject to underwriting depending on your state and your individual circumstances.
One more option that is not commonly known by most beneficiaries:
If you have joined a Medicare Advantage Plan for the first time and are dissatisfied with the plan, you will have special rights to purchase a Supplement if you revert to Original Medicare within 12 months of joining the Medicare Advantage Plan. This also holds true if you have joined a Medicare Advantage Plan when you first became eligible as well. You will be able to choose from any company. If you had a Supplement before joining the Medicare Advantage Plan for the first time, you may be able to get back into your same Supplement, if still offered. If not, you can purchase a Supplement from another company. If the previous Supplemental policy included prescriptions, it will no longer be able to offer the prescription coverage with the supplement, but you may be able to purchase a stand-alone Medicare Prescription Plan.