Medicare Advantage Part 2

MA

Medicare Advantage Course

Section 2 – Enrollment / Choices

NOTE: Availability of Medicare Advantage plans will vary by service area.  Carriers, benefit amounts, networks, and other factors vary per plan and are based on annual contracts.

Download the course notes here: SMS University Medicare Advantage Course Section 2 Enrollment

Underwriting

Beneficiaries must qualify for Medicare Advantage plans:

  • Reside in the service area
  • Have both Medicare A+B
  • Cannot have ESRD (End Stage Renal Disease)

Enrollment

Initial Enrollment Period

T65 (Turing 65 years old) – 7-month window

3 Months prior to the beneficiary’s 65th birth month

The Month of

3 Months after

Can enroll into any Medicare Advantage Plan

Annual Enrollment Period (AEP)

October 15th – December 7th can change to any Medicare Advantage or Part D plan for the following year

Special Election Periods (SEPs)

Special election periods occur when a Medicare beneficiary has a situation that will allow them to change plans outside of normal enrollment periods.  Some examples are:

  • Coming off group coverage
  • Moving to a new service area
  • Qualifying for certain additional assistance
  • Having both Medicare & Medicaid

More details can be found on page 94 of the Medicare & You Publication

Medicare Advantage Disenrollment Period (MADP)

MADP occurs annually from January 1st through February 14th.  This enrollment period allows a Medicare Advantage member to leave their Medicare Advantage plan and return to original Medicare and enroll into a stand-alone prescription drug plan.

NOTE:  This enrollment period does provide a guarantee issue period into a Medicare Supplement (Medigap) plan.

Choosing Plans

One way to explain the differences between all the various Medicare Advantage plans is to focus on the two main factors for many beneficiaries when it comes to choosing a plan:

  1. Costs
  2. Network

Costs

All Medicare advantage plans follow the same summary of benefits (SOB).  The carriers determine how much of a co-pay or co-insurance their members will pay (up to certain amounts set by CMS; example the max out of pocket for all plans is $6,700).

Network

Networks will vary from plan to plan depending on the type of plan they are offering (example HMO vs. PPO) and their contracts with local providers.    It is important to make sure all your client’s providers are accessible when choosing a plan.

NOTE:  Most carriers recommend using their online provider directory for the most accurate network information.