Eligibility and Enrollment
To be eligible for Medicare Advantage, you must be enrolled in or eligible for Original Medicare (Part A and B). If you are enrolled in Original Medicare and ever drop your Part B coverage, you will, in fact, lose your Medicare Advantage plan.
If you want to opt for a Medicare Advantage plan, there are several enrollment periods you will need to take note of:
- Initial Enrollment Period: This period begins three months before you turn 65 and ends three months after turning 65. If you are under 65 but receive Social Security disability benefits, you will qualify for Medicare once you reach the 25th month of receiving these benefits. If this is the case for you, you have the option to enroll in a Medicare Advantage plan three months before your eligibility starts.
- Annual Enrollment Period: Starting on October 15 and ending December 7, you can enroll, add, change, or drop your current coverage. This means if you are enrolled in Original Medicare, you can change your coverage and enroll in a Medicare Advantage plan.
- Special Enrollment Period: The Special Enrollment period allows people to sign up for Medicare or choose a new Medicare Advantage plan or plan provider depending on some special circumstances, such as moving outside of your plan’s service area.
Benefits and Coverage
Medicare Advantage plans must offer the same coverage as Original Medicare, which is inpatient (hospital) and outpatient (medical) coverage. However, as also previously mentioned, these plans are designed to also provide additional benefits. These benefits include:
- Dental, vision, and hearing coverage
- Prescription drug coverage
- Transportation (for doctor visits)
- Fitness memberships
- Wellness programs
- Nutrition programs
- Adult day-care services
These benefits can vary by plan, so it is important to review your desired plan’s policy.
Types of Advantage Plans
There are various types of Advantage plans to choose from, the most popular ones being HMO (Health Maintenance Organization) Plans and PPO (Preferred Provider Organization) Plans. Other plans include:
- Medicare Medical Savings Account
- Special Needs Plans
Some Medicare Advantage plans have a $0 premium rate, but you still have to pay your Medicare Part B premium. However, the average Medicare Advantage premium in 2021 is expected to be $21 per month. Medicare Advantage also has a maximum out-of-pocket limit of $7,550.