Medicare Advantage differs from Original Medicare not only in its coverage but also in the times that you can join your program of choice. With Original Medicare, you have to wait until the General Enrollment Period (January 1 – March 31) to sign up for the first time — if you didn’t enroll during your Initial Enrollment Period (three months before your 65th birthday to three months after).
If you didn’t join a Medicare Advantage plan during your Initial Enrollment Period, you’ll have to wait until the Annual Enrollment Period (October 15 – December 7) to sign up, and your (new) coverage will kick in on January 1 of the next year.
How Do I Prepare for Annual Enrollment?
When deciding between healthcare plans for the upcoming year, it’s best to look at the situation from these perspectives:
- The plan you have now
- Current medical needs
- Providers you prefer
- How you want your coverage to work
The plan you have now can influence what you do during the Annual Enrollment Period. Every three months, you’ll get a Medicare Summary Notice that allows you to see how your Medicare plan worked in a real-life situation.
If you need dentures, hearing aids, or vision care, Original Medicare isn’t going to help with the costs. On the other hand, some Medicare Advantage plans will provide some of these additional benefits.
About PPO Plans
There are different Medicare Advantage plans sold in different states, but a Preferred Provider Organization (PPO) plan, in particular, gives its policyholders incentive for seeing in-network doctors, hospitals, and other healthcare providers. These preferred providers give you treatments at the highest discounts. If the doctors you already see are in this network, this type of plan is the perfect one to switch to.
HMO and PFFS Plans
But there may be other options, depending on your needs and location. A Health Maintenance Organization (HMO) plan will give you the typical benefits of Medicare Advantage, but in most cases, you’ll have to choose a primary care physician (PCP) AND get a referral to go to a specialist.
If you’re looking for a plan that lets you see any Medicare-approved doctor or hospital that accepts the plan’s payment terms (and agrees to treat you), then a Private Fee-for-Service (PFFS) plan will be the one for you.
These are just a few examples of the choices you have leading up to the fall Annual Enrollment Period.
What Else Can I Do During Annual Enrollment?
This period isn’t limited to joining Medicare Advantage for the first time. Part D, which is Medicare’s prescription drug benefit, is also available for first-time enrollment.
While many Medicare Advantage plans come with a built-in prescription drug coverage, others do not. Another option you have here is to join a stand-alone Part D plan if your Medicare Advantage plan excludes it.
You’re also able to switch from one Medicare Advantage plan to another during this time. However, you cannot join Original Medicare during the Annual Enrollment Period and then promptly switch to a Medicare Advantage plan.
When The Time Comes, We’re Here to Serve You.
Carolina Senior Benefits is here for you, day in and day out. We answer any Medicare questions, and during Annual Enrollment, we can help you join Medicare Advantage for the first time — or help you switch to a different plan that provides the coverage you’re looking for. When you’re ready to explore your options, please contact our agency!