Frequently Asked Questions (FAQs)

1. What is the Annual Enrollment Period (AEP)?

The AEP is a time each year when Medicare beneficiaries can make changes to their Medicare health and prescription drug plans. It runs from October 15 to December 7.

2. What changes can I make during the AEP?

You can:

• Switch from Original Medicare to a Medicare Advantage Plan (or vice versa).
• Change from one Medicare Advantage Plan to another.
• Enroll in a Medicare Part D prescription drug plan or switch to a different one.
• Drop your Medicare Part D coverage.

3. How do I know if I need to change my plan?

Review your current plan’s Annual Notice of Change (ANOC) which you should receive in the mail. Compare it with other available plans to ensure it still meets your needs. Factors to consider include changes in premiums, coverage, or provider networks.

4. Can I make changes outside of the AEP?

Yes, there are Special Enrollment Periods (SEPs) that allow changes outside of AEP under specific circumstances, such as moving to a new area, losing other insurance coverage, or qualifying for Extra Help.

5. What if I missed the AEP?

If you missed the AEP, you may have to wait until the next AEP or qualify for a Special Enrollment Period. However, you can still review your options and seek advice from a Medicare counselor or insurance agent.

6. How do I enroll or switch plans?

Contaact me, your trusted agent, Randall Garcia by phone 210-823-1078 or by email: [email protected].  You can also attend one of my scheduled events.

7. What should I consider when choosing a new plan?

Consider the following:

• Monthly premiums and out-of-pocket costs.
• Coverage of your current medications.
• Network of doctors and healthcare providers.
• Additional benefits like vision or dental coverage.

8. Will my current plan automatically renew?

Most plans will automatically renew unless you make changes during the AEP. However, it’s still important to review your plan’s changes and compare other options to ensure your coverage meets your needs.

Frequently Asked Questions About Medicare Advantage Plans

1. What is a Medicare Advantage Plan?

A Medicare Advantage Plan (also known as Medicare Part C) is a type of health insurance plan that combines coverage from Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) into one plan. Some plans also include Medicare Part D (Prescription Drug Coverage) and additional benefits such as vision, dental, and hearing services.

2. How do Medicare Advantage Plans differ from Original Medicare?

Medicare Advantage Plans offer an alternative to Original Medicare. Unlike Original Medicare, which is managed by the federal government, Medicare Advantage Plans are offered by private insurance companies. They often include additional benefits not covered by Original Medicare and may have different cost structures, such as lower out-of-pocket costs or co-pays.

3. What types of Medicare Advantage Plans are available?

There are several types of Medicare Advantage Plans:

• Health Maintenance Organization (HMO) Plans: Require you to use a network of doctors and hospitals and usually require a referral to see a specialist.
• Preferred Provider Organization (PPO) Plans: Offer more flexibility in choosing healthcare providers and do not require referrals for specialists, though using network providers may be cheaper.
• Private Fee-for-Service (PFFS) Plans: Allow you to see any provider that accepts the plan’s terms, but costs can vary.
• Special Needs Plans (SNPs): Tailored for individuals with specific health needs, such as chronic conditions or institutional care.

4. Can I keep my current doctors with a Medicare Advantage Plan?

It depends on the plan you choose. HMO and PPO plans typically have networks of doctors and hospitals. To keep your current doctors, you’ll need to ensure they are part of the plan’s network. PFFS plans and some PPO plans may offer more flexibility but still may have network restrictions.

5. What are the costs associated with Medicare Advantage Plans?

Costs can vary widely among plans but typically include:

• Monthly premiums: Some plans have a $0 premium, but most require a monthly payment.
• Deductibles: The amount you must pay out-of-pocket before the plan begins to pay.
• Co-pays and co-insurance: Fees for doctor visits, hospital stays, and other services.
• Out-of-pocket maximum: The maximum amount you’ll pay for covered services in a year.

6. Are Medicare Advantage Plans required to cover everything Original Medicare covers?

Yes, Medicare Advantage Plans must cover all services that Original Medicare covers except for hospice care, which is still covered by Original Medicare. Many plans also offer additional benefits not covered by Original Medicare.

7. How do I enroll in a Medicare Advantage Plan?

You can enroll during the Annual Enrollment Period (October 15 - December 7) or during a Special Enrollment Period if you qualify. Enrollment can be done through Medicare.gov, by calling 1-800-MEDICARE, or through a licensed Medicare insurance agent.

8. Can I switch Medicare Advantage Plans or change back to Original Medicare?

Yes, you can switch Medicare Advantage Plans during the Annual Enrollment Period or during the Medicare Advantage Open Enrollment Period (January 1 - March 31). You can also switch back to Original Medicare, but this may involve changes in coverage and costs.

9. What if I need emergency care while traveling?

Most Medicare Advantage Plans offer emergency care coverage nationwide, but the specifics can vary. Always check with your plan to understand your coverage and any potential out-of-network costs when traveling.

10. Are there any eligibility requirements for Medicare Advantage Plans?

To be eligible, you must:

• Be enrolled in Medicare Part A and Part B.
• Live in the plan’s service area.
• Not have end-stage renal disease (ESRD), although there are exceptions and special plans for people with ESRD.

11. How can I compare Medicare Advantage Plans?

Use the Medicare Plan Finder tool on Medicare.gov to compare plans based on premiums, out-of-pocket costs, coverage, and provider networks. You can also review plan details in the plan’s Summary of Benefits and Annual Notice of Change documents.

12. What is the difference between Medicare Advantage and Medigap (Medicare Supplement Insurance)?

Medigap policies are supplemental insurance plans that work alongside Original Medicare to cover additional costs like co-pays and deductibles. Medicare Advantage Plans replace Original Medicare and may offer more comprehensive coverage, including additional benefits.