What Is Medicare Advantage Program?

What Is Medicare Advantage Program?

Medicare Advantage is a program that pays most of the costs for health care you receive from a health plan.

Medicare Advantage plans are run by private companies or local or state government agencies.

There are more than 250 Medicare Advantage plans.

You can join Medicare Advantage if you are enrolled in Original Medicare (Parts A & B), or if you are covered by some other health insurance coverage.

With a Medicare Advantage plan, you'll usually get all your Part A, Part B, and prescription drug benefits through your plan without any additional cost.

These are some of the benefits of Medicare Advantage:

You can choose your own health care providers.

You have free choice of doctors and other health care providers.

You can usually get all your Part A, Part B, and Prescription Drug (Part D) benefits through your plan without having to pay an additional fee for them.

You do not need to file a separate application. You can enroll in a Medicare Advantage plan during the same time you enroll in or change your Original Medicare coverage.

You can change from one Medicare Advantage plan to another during the first 6 months of each year.

If you have Part A and Part B, you can join a Medicare Advantage plan instead of Part D.

If you have Original Medicare Parts A & B and you have been diagnosed with End-Stage Renal Disease (ESRD) you can join a Medicare Advantage plan instead of Part D.

With Original Medicare Parts A & B and End Stage Renal Disease, you can join a Medicare Advantage plan instead of Part D.

If you have Part A and Part B, and you live in a long-term care facility, you can join a Medicare Advantage plan instead of Part D.

Medicare Advantage plans generally offer the same Part D prescription drug coverage as Original Medicare.

You have the right to appeal a decision of your plan to deny a claim or cancel your coverage.

Ways you can enroll in a Medicare Advantage plan

You can enroll in a Medicare Advantage plan when you:

Have an illness or injury.

Move into a new area.

Are going to be out of the country.

Are switching from one Medicare Advantage plan to another.

Are changing your Part D plan.

Are already enrolled in Medicare Advantage

You can change plans during the first six months of each year. It is best to visit your plan's website or contact your plan to find out if you are eligible to change plans.

If you are a new enrollee, you'll have a 14-day waiting period during which you can change your mind.

If you do change your Medicare Advantage plan, you may lose your coverage for the rest of the month in which you enrolled. So, you should not enroll during the last month of the year.

Note: If you are in a Medicare Advantage plan area that is changing to another plan, you will have to switch plans at the end of the month. You will not have to wait for the next renewal period.

If you change plans or leave your Medicare Advantage plan, you will have a seven-day special election period to pick a different plan. If you do not choose a different plan during this special election period, you will remain enrolled in your current plan.

You may have to pay a fee for leaving your plan if you are enrolled during the Part D enrollment period and it is the middle or end of the year (January 1 to March 31).

About Medicaid

Medicaid is a low-cost health insurance program for people with limited income.

You may be eligible for Medicaid if you meet the following requirements:

You are under 65 years of age.

Your income is low.

You have limited assets.

You are pregnant, blind, or disabled.

You are 65 or older and have low income and limited assets.

Medicaid may pay all or part of the cost of your health care. It will not pay for health care that is covered by Medicare, your private insurance, Indian Health Services, or your employer's insurance.

You will have no cost-sharing expenses such as deductibles, coinsurance, or copayments.

People on Medicaid are allowed to use any doctor or other provider who is approved by the plan.

Medicaid may pay for most of your health care costs, or only a portion. It depends on your income, the amount of assets you have, and the services you need.

People on Medicaid may pay small copayments for certain services, such as prescription drugs.

Medicaid is not the same as Medicare. You can have Medicaid and Medicare at the same time.

For more information about Medicaid, contact your state's Medicaid agency. You may also contact your local department of health or social services or local county agency. You can get information about Medicaid from Medicaid's website or by calling Medicaid at 1-800-MEDICARE (1-877-690-1012) or TTY: 1-877-690-1012.

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