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Open enrollment begins in October and ends in early December. If you feel you qualify for a Special Enrollment Period. Call one of our agents today to discuss your options!

You can generally join one of these Medicare Advantage plans:

  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3. Private Fee-for-Service (PFFS)
  4. Medical Savings Account (MSA) Plan

If all of these apply:

  1. You live in the service area of the plan you want to join. The plan can give you more information about its service area. If you live in another state for part of the year, ask if the plan will cover you there.
  2. You have Medicare Part A and Part B.
  3. You don’t have End-Stage Renal Disease.

How to switch

If you’re already in a Medicare Advantage Plan and want to switch, follow these steps:

  1. To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.
  2. To switch to Original Medicare, contact your current plan, or contact Total Care Consultants.
  3. Unless you have other drug coverage, you should carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year.

If you have other coverage

Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose employer or union coverage. If you lose coverage for yourself, you may also lose coverage for your spouse and dependents.

In other cases, you may still be able to use your employer or union coverage along with the Medicare Advantage plan you join. Remember, if you drop your employer or union coverage, you may not be able to get it back.

At the end of the year, plans can decide to leave the Medicare Program. If your plan leaves, you’ll get a letter explaining your options.

Generally, you’ll be automatically returned to Original Medicare if you don’t choose to join another Medicare Advantage Plan. You will also have the right to buy a Medigap policy.

No matter what you choose, you’re still in the Medicare Program and will get all Medicare-covered services. If you choose to go back to Original Medicare, you need to decide if you want drug coverage. If so, you need to join a Medicare Prescription Drug Plan (Part D).

If you have ESRD, you’ll usually get your health care through Original Medicare. You can only join a Medicare Advantage Plan (Part C) in certain situations, like these:

  1. You’re already in a Medicare Advantage Plan when you develop ESRD. You may be able to stay in your plan or join another plan offered by the same company.
  2. You’re already getting your health benefits (for example, through an employer health plan) through the same organization that offers the Medicare Advantage Plan.
  3. You had ESRD, but have had a successful kidney transplant, and you still qualify for Medicare benefits (based on your age or a disability). You can stay in Original Medicare, or join a Medicare Advantage Plan.
  4. You may be able to join a Medicare Special Needs Plan (SNP) for people with ESRD if one is available in your area.

You have a one-time right to join another plan if both of these are true:

    1. You have ESRD and are in a Medicare Advantage Plan
    2. The plan leaves Medicare or no longer provides coverage in your area
    3. You don’t have to use your one-time right to join a new plan immediately.

If you go directly to Original Medicare after your plan leaves or stops providing coverage, you’ll still have a one-time right to join a Medicare Advantage Plan later.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

Covered services in Medicare Advantage Plans

Medicare Advantage Plans cover all Medicare services. Some Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage. Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:

      1. Whether you need a referral to see a specialist
      2. If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care
      3. These rules can change each year.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. Contact us to learn more.

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

      1. Can’t offer drug coverage (like Medicare Medical Savings Account plans)
      2. Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

      1. You’re in a Medicare Advantage HMO or PPO.
      2. You join a separate Medicare Prescription Drug Plan.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans

Medigap policies can’t work with Medicare Advantage Plans. Learn more about these plans by contacting Total Care Consultants.

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