Learn about costs and coverage of Medicare Advantage Plans and when you can enroll.
|1. Medicare Advantage plans cover the same services as the federal government’s Medicare Parts A and B and provide additional benefits.||2. You can sign up for Medicare Advantage during your initial enrollment period for Medicare Part A and Part B, during the annual open enrollment period, or during a special enrollment period if you qualify.|
|3. You qualify for a Medicare Advantage plan if you are enrolled in Part A and B, don’t have a Medigap plan, and live in the service area of the plan you choose.||4. You can search for different types of Medicare Advantage plans. Coverage and costs vary, but the vast majority of Americans have access to at least one plan that offers drug coverage and no premium.|
Medicare Advantage plans are private health insurance policies that let you choose how you receive your Medicare coverage. These plans cover the same services as the federal government’s Medicare Parts A and B and provide additional benefits.
You can sign up for a Medicare Advantage plan if:
There are different types of Medicare Advantage Plans, and costs vary depending on benefits, insurer, and where you live. This guide provides information about who qualifies for Part C plans, what they cover, how to enroll, and the associated costs.
Original Medicare is the federal government’s health insurance program comprising Part A and Part B.
In most cases, you qualify for Medicare if you’re 65 years of age and either a U.S. citizen or have been a legal permanent resident for five consecutive years.
If you’re younger than 65, you may qualify for Medicare if you:
You can check if you qualify for Medicare using the federal government’s online eligibility tool.
Medicare Part A is a hospital insurance program. It helps cover costs if your doctor determines you need inpatient care in a hospital or medical facility. This includes:
Medicare Part B covers medically necessary services, such as:
You can qualify for Medicare Advantage if:
There are several ways to enroll in a Medicare Advantage plan.
You can sign up for Medicare Advantage during your initial enrollment period for Medicare Part A and Part B. This seven-month period begins three months before the month you turn 65 and ends three months after the month you turn 65.
If you sign up for Medicare Parts A and B during the general enrollment period of January 1st to March 31st, you receive a special enrollment period to register in a Medicare Advantage plan (April 1 to June 30).
You may also be eligible for a special enrollment period if you retire after age 65 and are no longer covered by a company health insurance plan, or if your circumstances change.
You can join or switch Medicare Advantage plans during the annual open enrollment period between October 15th to December 7th.
If you’re already enrolled in a Medicare Advantage plan, you can drop or switch plans during the Medicare Advantage Open Enrollment Period of January 1st to March 31st.
Medicare Advantage plans must provide coverage for the same services as traditional Medicare.
Many Medicare Advantage plans also offer additional benefits not included in Original Medicare. The federal government determines what benefits are permitted, and each plan covers a different mix of services.
When choosing a Medicare Advantage product, consider which benefits are important to you and understand how the plan determines eligible expenses. You can choose plans that cover:
Some Special Needs Plans are also customized for those with chronic conditions.
Some plans have higher initial costs but may cost less when you access the benefits. Other plans may have low monthly premiums or no premiums but charge a higher fee when you use them.
When comparing Medicare Advantage plans, it’s important to consider all of the costs that you may end up paying.
Unlike Original Medicare, Medicare Advantage plans must limit your annual out-of-pocket costs. Once you’ve reached the plan’s annual limit, you can’t be asked to pay more. Monthly premiums are typically not considered an out-of-pocket cost.The federal government has an online tool to help you find a plan in your service area and compare benefits and costs.
Roseann Birch has worked in the insurance industry for more than 35 years. In 2006, she moved to selling insurance and, by 2009, Birch made Medicare her area of expertise after observing the struggles of older adults to understand Medicare. Although many adults age 65 and older are eligible for Medicare, nearly just as many don’t understand how it works.
Birch has learned the ins and outs of Medicare and its variations and supplements to help beneficiaries and their families understand benefits. She finds there is often misinformation and makes it her mission to clear up the confusion so that everyone can enjoy the full extent of Medicare benefits.