October 6, 2016
Medicare Advantage, also known as Medicare Part C, provides an alternative way for Medicare beneficiaries to receive their Original Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide Original Medicare, Part A and Part B benefits to those who decide to enroll.
Enrolling in a Medicare Advantage plan doesn’t mean that you no longer have Medicare Part A and Part B. It means you decided to receive your Medicare benefits from a private health insurer contracted with Medicare in North Carolina rather than directly from the federal government-administered program. In fact, you must continue paying your Part B premium if you enroll in a Medicare Advantage plan.
Medicare Advantage plans are required to provide the same coverage that Original Medicare Part A and Part B provides, with the exception of hospice care which remains covered by Medicare Part A. While this is the minimum coverage Medicare Advantage plans must provide, these plans commonly offer additional benefits, such as routine vision, dental, hearing, and wellness programs. Many Medicare Advantage plans, known as Medicare Advantage Prescription Drug plans (MA-PDs), also include prescription drug coverage. You may have a Medicare Advantage plan premium, as well as the Medicare Part B premium, to pay monthly. Medicare Advantage plan premiums vary and some plans may offer insurance premiums as low as $0.
There are several times throughout the year when you generally can enroll in a Medicare Advantage plan in North Carolina, as in other states.
Initial Coverage Election Period (ICEP) is the time period for enrolling in a Medicare Advantage plan when you are first eligible to do so.
The Annual Election Period (AEP) takes place every year from October 15 through December 7. This is for Medicare beneficiaries who would like to go from Original Medicare to a Medicare Advantage plan, from one Medicare Advantage plan to another, or from a Medicare Advantage plan back to Original Medicare.
The Medicare Advantage Disenrollment Period goes from January 1 to February 14 of each year. During this period, the only changes a Medicare beneficiary can make are to leave Medicare Advantage in favor of going back to Original Medicare (Part A and Part B), and then enroll in a stand-alone Medicare Part D Prescription Drug Plan to go alongside their Original Medicare coverage. You cannot go from one Medicare Advantage plan to another during this time.
A Special Enrollment Period (SEP) provides an opportunity to enroll in a Medicare Advantage plan outside the normal enrollment periods in some cases. For example, if you move to or from a skilled nursing facility (or if you’re living in one), or if you had Medicaid but are no longer eligible for it, you might qualify for a Special Enrollment Period (SEP). For other examples and for more information, see Medicare Special Enrollment Periods.
There are varying types of Medicare Advantage plans. Some of the types are determined by the arrangements the Medicare Advantage plans have with health-care providers participating in their networks and the corresponding benefits that are available when plan members use network participating health-care providers. It’s important to understand the differences so that you can find one that works best for you.
Remember that if you decide to sign up for a Medicare Advantage plan, you continue paying your Medicare Part B premium in addition to any premium the plan may charge.
As a Medicare beneficiary in North Carolina, you may find it useful to compare all the Medicare Advantage plans available in your area.
The availability and costs of Medicare Advantage plans generally depend on your county of residence, the insurance company offering the Medicare Advantage plan, and the plan’s specific benefit details. You may find that some Medicare Advantage plans in North Carolina offer premiums as low as $0, but you might want to also consider the plan’s other costs such as copayments and deductibles. (Keep in mind that you continue to pay your monthly Medicare Part B premium, no matter which Medicare Advantage plan you choose.) Some further considerations to keep in mind when selecting a Medicare Advantage plan:
You can see why it’s important to compare Medicare Advantage plans to find one that offers benefits and costs suited to your personal health and budget requirements.
To start comparing Medicare Advantage plans in North Carolina right away, enter your zip code above for a list of plans available in your area. You can also enter the names of your prescription drugs to further customize your search and cost estimates.
To learn more about Medicare in North Carolina, you are invited to review the following resources:
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.