2Medicare Advantage Open Enrollment Period lasts until March 31.
From January 1 through March 31, beneficiaries are allowed one opportunity to change the way they receive their Medicare health insurance benefits. This period is known as the Medicare Advantage Open Enrollment Period. Medicare Advantage Plans are designed to provide Medicare beneficiaries with all the benefits they currently receive from Medicare, but with an advantage. This advantage comes in the form of additional benefits, such as routine vision care (e.g. glasses), and gym memberships.
There are various types of Medicare Advantage plans, including Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) Private Fee for Service Plans (PFFS), Special Needs Plans (SNP) and Medical Savings Accounts (MSA).
Beneficiaries can choose to enroll in a plan that is a Managed Care plan, such as an HMO. An HMO is designed to coordinate all of a beneficiary’s care through a network of providers. Generally beneficiaries can only go to doctors, specialists, or hospitals that are within the plan’s network, or medical group. Another type of plan is a PPO, which allows you to see providers both in network and out of network. Often with this type of plan, you will pay less if you use doctors, hospitals, and providers that belong to the plans PPO network, also you may have to meet an annual deductible. The third kind of Medicare Advantage plan is a PFFS. This plan is different in that you may use any Medicare-approved doctor, hospital or provider to receive services. However, you need to verify with the provider that they will accept the PFFS plan’s terms and conditions for payment. Next are Special Need Plans, which are specifically designed to provide more focused and specialized health care for three different groups of people: (1) beneficiaries who have both Medicare and Medicaid (Medi-Cal in California), (2) beneficiaries who reside in a nursing home, and (3) beneficiaries with certain chronic medical conditions. The last form of a Medicare Advantage plan is Medical Savings Accounts. These are a two-part plan that has an HMO or PPO component with a high deductible and a Medical Savings Account.
Medicare Advantage Plans can come with or without prescription drug coverage. If the plan has prescription drug coverage than the plan has Medicare prescription drug coverage, or Part D, built into the benefit and it is called a MA-PD. If the plan does not have prescription drug coverage than it is called an MA-Only plan.
During the Medicare Advantage Open Enrollment Period, beneficiaries are allowed to change for “like coverage.” In other words, if you have both medical coverage and Medicare prescription drug coverage (Part D) you must keep medical coverage and Part D prescription drug coverage. Alternately the reverse is also true. If you only have medical coverage and you do not have Medicare prescription drug coverage (Part D), then you must keep medical coverage without Part D prescription drug coverage. The only type of Medicare Advantage Plan which is closed for enrollment during the Open Enrollment Period is the Medical Savings Account. This means you cannot enroll into, or dis-enroll from a Medical Savings Account during the Medicare Advantage Open Enrollment Period.
The following chart illustrates changes that can be made during this Open Enrollment Period:
Current Coverage… |
Can Enroll into… |
Medicare HMO with Drug Coverage |
Different Medicare HMO with Drug coverage |
Medicare PPO with Drug Coverage |
Different Medicare PPO with Drug coverage |
Medicare PFFS with Drug Coverage |
Different Medicare PFFS with Drug coverage |
Original Medicare with Stand Alone Part D plan |
Medicare HMO with Drug coverage |
|
|
Medicare HMO without Drug Coverage |
Different Medicare HMO without Drug coverage |
Medicare PPO without Drug Coverage |
Different Medicare PPO without Drug coverage |
Medicare PFFS without Drug Coverage |
Different Medicare PFFS without Drug coverage |
Original Medicare |
Medicare HMO without Drug coverage |
For more information about the Medicare Advantage Open Enrollment Period, or to compare your options, call 1-800-434-0222 to speak with a Registered HICAP Counselor, or e-mail us at ask-hicap@inlandagency.org.