Medicare Part C (Medicare Advantage Plans)

What is Medicare Part C?

Medicare Part C allows private health insurance companies, such as Priority Health, to provide Medicare benefits in addition to what’s covered by Original Medicare (Parts A and B). These Medicare private health plans that include HMOs, POSs and PPOs, are known as Medicare Advantage plans, or MAPD plans when they include Part D prescription drug coverage.

With MAPD plans, you have just one card and one company to use for all your medical and pharmacy needs.

Why enroll in Medicare Part C?

Also known as Medicare Advantage with prescription drug (MAPD) plans, Medicare Part C can help lower your out-of-pocket costs with predictable copayments, lower deductibles and out-of-pocket maximums. MAPD plans also cover prescription drugs, and can include extras, like dental or a gym membership. A Medicare Part C plan may be right for you if:

  • You want predictable copayments, deductibles and an out-of-pocket maximum
  • Paying a lower monthly premium is important to you
  • You want to have your Part D prescription coverage bundled with your Parts A and B coverage
  • You want additional coverage even though you have a pre-existing condition
  • You want to save money by seeing doctors in the plan’s network

Am I eligible for Medicare Advantage?

To be eligible for Medicare Advantage plans:

  • You must have both Medicare Part A and Part B. (Note: You must continue to pay your Medicare Part B premium once you enroll.)
  • You must be a permanent Michigan resident and reside in our service area for at least 6 months of the year.
  • You can’t be denied for pre-existing conditions unless you've been diagnosed with end stage renal disease (ESRD). In this case, see the Medicare & You handbook for additional eligibility opportunities.

When can I enroll?

You can enroll in Medicare Advantage during:

  • Your Initial Coverage Election Period (ICEP)
  • Annual Election Period (AEP)
  • Special Election Period (SEP)

Initial Coverage Election Period (ICEP)

This is the 7-month period that begins 3 months before your initial entitlement to Part A and Part B (usually your 65th birthday month).

During this time, you can elect to have just Original Medicare (Parts A and B) or add extra coverage with a Medicare Advantage or Medigap plan.

Annual Election Period (AEP)

AEP runs from Oct. 15 – Dec. 7 each year, and is generally the one time of year you can make changes to your plan. If you don’t already have a Medicare Advantage plan, you can choose to enroll in one during this time. If you are currently enrolled in a Medicare Advantage plan, you can choose a different plan. If you do decide to make changes, your coverage is effective on Jan. 1.

Special Election Period (SEP)

These are periods of time outside of the ICEP or AEP when an individual can change his or her current plan. Some examples are:

  • If you move outside the plan's service area
  • If you are enrolled in both Medicare and Medicaid
  • If you qualify for low-income subsidy
  • If you lose creditable drug coverage from your employer
  • If your plan is no longer offered
  • If your plan is terminated by Medicare

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