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Medicare Advantage PlansChoose Your State and Learn

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About Medicare Advantage Health PlansAlso known as Medicare Part C and MA Plans for Seniors

Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called "Part C" or "MA Plans." Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually copayments but can also be coinsurance and deductibles. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren't supplemental insurance. Not all Medicare Advantage Plans work the same way, so find out the plan's rules before joining. To find Medicare Advantage plans in your area click on your state below:

You may need a referral to see specialists. Some Medicare Advantage Plans have provider networks. In some cases this means you can only see doctors who belong to the plan or go to certain hospitals to get covered services (other than for emergency or urgently needed care or medically-necessary dialysis). In some plans, if you see a doctor or other provider who doesn’t contract or participate with the plan, your services may not be covered at all, or your costs will likely be higher. You should check with your doctors or hospital to find out if they accept the plan. It’s important to call any plan before joining to find out the plan’s rules, what your costs will be, and to make sure the plan meets your needs. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (usually for an extra cost).

Who Can Join Medicare Advantage Programs?

You can generally join a Medicare Advantage Plan if you meet these conditions: You have Medicare Part A and Part B. You live in the service area of the plan. You don’t have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) except in certain instances. In most cases, you can join a Medicare Advantage Plan only at certain times during the year.

As with Original Medicare, you still have Medicare rights and protections, including the right to appeal. Check with the plan before you get a service to find out whether they will cover the service and what your costs may be. You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease. In most cases, you are enrolled in a plan for a year. If you see a doctor who doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan. If the plan decides to stop participating in Medicare, you will have to join another Medicare health plan or return to Original Medicare.

Medicare Advantage and Medigap Policies

If you sign-up for a Medicare Advantage Plan you do not need and are no longer eligible to buy Medigap Supplemental Insurance policies. Medigap will not cover your Medicare Advantage Plan deductibles, copayment, or coinsurance.

Joining, Switching and Dropping a Medicare Advantage Health Plan

You can join, switch, or drop a Medicare Advantage Plan at these times: When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65). If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. Between November 15 - December 31 each year. Your coverage will begin on January 1 of the following year. Between January 1 - March 31 of each year. However, you can’t join or switch to a plan with prescription drug coverage during this time unless you already have Medicare prescription drug coverage (Part D). You also can’t drop a plan with prescription drug coverage or join, switch, or drop a Medicare Medical Savings Account Plan during this period. In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. Some of these situations include the following: If you move out of your plan’s service area If you have both Medicare and Medicaid

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