Frequently Asked Questions
Medicare Advantage Plan FAQs
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The out-of-pocket costs for a Medicare Advantage Plan vary widely, and depend on the following:
Whether the plan charges a monthly premium in addition to your Part B premium.
Whether the plan pays any of the monthly Part B premium.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayments).
The type of health care services you need and how often you get them.
Whether you follow the plan’s rules, like using network providers.
Whether you need extra coverage and what the plan charges for it.
Whether the plan has a yearly limit on your out-of-pocket costs for all medical services.
A few Medicare Advantage plans may pay all or part of your Part B premium. (You still get all Part A and Part B covered services). Your Medicare Advantage plan premium may also include all or part of the premium for Medicare prescription drug coverage (Part D).
If you have limited income and resources, you may qualify for the following:
Extra help paying for your Part D premium and other prescription drug coverage costs.
Help from your state to pay your Part B premium.
For More Information:
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
Visit www.medicare.gov/Pubs/pdf/10126.pdf to view the brochure, “Get Help With Your Medicare Costs: Getting Started.” You can learn more by reading Medicare & You, the official government handbook about Medicare. *You will need the free Adobe® Reader® software to download the files.
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You can join, switch, or drop a Medicare Advantage Plan at these times:
You can join, switch, or drop a Medicare Advantage Plan at these times:
When you first become eligible for Medicare (the 7-month period begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65).
If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. You will have another chance to join 3 months before the month you turn age 65 to 3 months after the month you turn age 65.
During the Annual Election Period between October 15-December 7. Your coverage will begin on January 1 of the following year, as long as the plan gets your enrollment request by December 31.
Medicare Advantage enrollees have an annual opportunity to prospectively disenroll from any Medicare Advantage plan and return to Original Medicare between January 1 and February 14 of every year. This is known as the Medicare Advantage Disenrollment Period (MADP). Disenrollment requests received during this MADP will be processed for the first of the following month. Regardless of whether the MA plan included Part D drug coverage, MA enrollees using the MADP to disenroll from MA from January 1 through February 14 are eligible for a Special Election Period (SEP) to enroll in a Prescription Drug Plan (PDP) and may request enrollment in a PDP during the same time frame. This does not apply to members of Private Fee-For-Service Medicare Advantage-Only (PFFS MA-Only) plans who are also enrolled in separate prescription drug plans (PDPs). An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment request from the MA plan during the MADP or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Individuals enrolled in MA-only PFFS plans must request disenrollment from the MA-only plan in order to be eligible for this SEP, as enrollment in a PDP will not result in automatic disenrollment from the MA-only plan.
In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. This is referred to as a Special Election Period (SEP). For a full list of qualifying circumstances, please visit Medicare.gov. Some of these situations include the following:
If you move out of your plan’s service area
If you moved to a new address that is still in your plan’s service area, but have new plan options in your new location
If you have both Medicare and Medicaid
If you qualify for Extra help to pay for your prescription drug costs
If you live in an institution (like a nursing home)
Medicare Plan D FAQs
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Part D plans may have a monthly plan premium and a yearly deductible. These vary from plan to plan. You pay a portion of your drug costs, including a copayment or coinsurance. Costs vary depending on which drug plan you choose. Coverage options, including drug coverage, may vary from plan to plan.
You may be able to get extra help to pay for your prescription drug premium and costs. To find out whether you qualify for Extra Help, call:
1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
The Social Security Administration, 1-800-772-1213 (TTY users, call 1-800-325-0778)
Your state Medicaid office
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To join a Medicare Prescription Drug Plan, you must have Part A and/or Part B. If you would like to get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.
Important Note for Medicare Beneficiaries with Employer or Union Coverage:
If you have employer or union coverage, call your benefits administrator before you make any changes, or before you sign up for any other coverage. If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents.
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You can join, switch, or drop a Medicare drug plan at these times:
When you are first eligible for Medicare (the 7-month period begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65).
If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. You will have another chance to join 3 months before the month you turn age 65 to3 months after the month you turn age 65.
The Annual Enrollment Period, between October 15-December 7. Your coverage will begin on January 1 of the following year, as long as the plan gets your enrollment request by December 31.
Anytime, if you qualify for Extra Help or if you have both Medicare and Medicaid.
In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans during a special enrollment period (like if you move out of the service area, lose other creditable prescription drug coverage, or live in an institution).
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Even if you don’t take a lot of prescription drugs now, you should still consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage (for example from an employer or union that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage), you will likely pay a late enrollment penalty (higher premiums) if you join later.
Note: Discount cards, doctor samples, free clinics, drug discount Web sites, and manufacturer’s pharmacy assistance programs are not considered prescription drug coverage and are not considered creditable coverage.
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Depending on your circumstances, you can switch to a new Medicare drug plan simply by joining another drug plan during one of the times listed above. You don’t need to cancel your old Medicare drug plan or send them anything. Your old Medicare drug plan coverage will end when your new drug plan begins. You should get a letter from your new Medicare drug plan telling you when your coverage begins.