Resources for Seniors: Medicare Advantage 101

Your most asked questions below about Medicare Advantage. 

What is the difference between Medicare Advantage and traditional Medicare?

With Medicare Advantage your health coverage is provided through a private plan rather than the federal government. Unlike traditional Medicare, for which you pay a separate monthly premium for Part A (Hospital), Part B (Doctors, Outpatient), and Part D (Prescription Drugs), Medicare Advantage covers all Parts A, B, and if selected, Part D all in one monthly premium, often at a lower cost to you. Medicare Advantage plans often cover additional benefits, such as dental, hearing, vision and transportation coverage at no additional cost.

If I'm in a Medicare Advantage plan, will I receive Part A and B benefits? Will I receive Part D?

Yes, Medicare Advantage plans are required to cover all Part A and B benefits provided under traditional Medicare. There are many plans that offer Part D prescription drug coverage that you may choose to add.

Can I switch from Medicare to a Medicare Advantage plan at any time?

No, but you can switch from Medicare to a Medicare Advantage plan during the open enrollment period, which lasts from October 15 to December 7.

Can I qualify for a Medicare Advantage plan with a pre-existing condition?

You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).

Where can I go to explore my options?

To research plans and determine which plan may be right for you, click here.

What does initial enrollment period mean? 

Your Initial Enrollment Period is when you first become eligible for Medicare or when you turn 65.  In general, you can enroll in Medicare Part A, B and C (Medicare Advantage) during your Initial Enrollment period which is the 7 months surrounding your 65th birthday.  

Who will my doctor be?

Medicare Advantage plans provide a list of doctors and hospitals for your review. Be sure you are choosing a plan that includes the provider you need.

What if I receive benefits from Social Security or the Railroad Retirement Board?

When you turn 65, you will automatically be enrolled in Medicare Part A and Medicare Part B if you are receiving benefits from Social Security or the Railroad Retirement Board.

If I am enrolled in Medicare Part A & B, do I have to re-enroll each year?

You only have to re-enroll if you switch to Medicare Advantage or want to switch back.

Under what special circumstances can I sign up for Medicare Advantage?

You can sign up for Medicare Advantage if:

  • You're no longer eligible for Medicaid. 
  • You find out that you won't be eligible for Extra Help for the following year. 
  • You leave coverage from your employer or union. 
  • You drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.

KEY DATES

The Annual Election Period runs from October 15 to December 7. 

Your coverage will begin January 1 of the following year, as long as the plan gets your enrollment request by December 7.

What can I do during this period?

■ Change from Original Medicare to a Medicare Advantage Plan.

■ Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

■ Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.

■ Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.

If you are getting Part B for the first time you can sign up for an Advantage Plan during your initial coverage election period between April 1-June 30.