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Ashford Insurance

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Ashford Insurance is an Independent Marketing Organization working with United HealthCare Medicare Solutions.

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Have Questions About Medicare? - Plans Starting At $0/Month

Ashford Insurance

Medicare Insurance Made Easy

817-952-3153

Have Questions About Medicare? – Plans Starting At $0/Month

About Medicare Advantage

Whether you’re already in a Medicare Advantage plan, you’re curious about them, or you’ve never heard of them, this guide is for you. In this in-depth Medicare Advantage guide, we’ll provide answers to the most frequently asked questions.

Who Qualifies for Medicare Advantage?

To qualify for Medicare Advantage, you must be enrolled in Original Medicare Parts A and Medicare Part B. You also must continue to pay your Part B premium in order to keep your Medicare Advantage coverage.

There are no age restrictions for Medicare Advantage plans. If you’re enrolled in Part A and B before age 65 due to a disability or chronic condition, you’re still eligible for Medicare Advantage coverage.

Enrolling In Medicare Advantage for the First Time

If you’re turning 65, you can enroll in Medicare Advantage during your Initial Enrollment Period (IEP). Your IEP lasts for 7 months, which begins 3 months before your 65th birthday, includes that birthday month, and ends 3 months after you turn 65.

If you’re under 65, your first chance to enroll in Medicare Advantage starts:

  • After your 24th month of receiving Social Security disability benefits, or
  • At any age, if you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gherig’s Disease,
  • or if you have End-Stage Renal Disease (ESRD).

Changing Your Medicare Coverage During AEP

The Medicare Open Enrollment Period, also called the Medicare Annual Enrollment Period or Annual Election Period, is a suitable time to decide whether Medicare Advantage or Original Medicare is right for you.
Keep in mind that Medicare Advantage plan benefits can change annually. So if you have a MA plan, you should check to make sure the plan still meets your needs.

Here are the actions you can take during AEP:

  • Change from Original Medicare to a Medicare Advantage plan.
  • Change from one Medicare Advantage plan to another.
  • Disenroll from your Medicare Advantage plan and go back to Original Medicare.
  • Change from one prescription drug plan (Medicare Part D) to another.
  • Enroll in a prescription drug plan.
  • Cancel your prescription drug coverage.

If you enroll in or switch your Medicare Advantage insurance during AEP, your new coverage will be effective on January 1st of the following year.

You may also be able to enroll in a Medicare Supplement plan if you drop your Medicare Advantage coverage during AEP.

Medicare Advantage Open Enrollment Period

If you’re enrolled in a Medicare Advantage plan, you have access to another enrollment period beyond AEP: The Medicare Advantage Open Enrollment Period (MA-OEP).

MA-OEP runs from January 1 to March 31 of each year. During the MA-OEP, you can:

  • Change from one Medicare Advantage plan to another.
  • Drop Medicare Advantage, and return to Original Medicare.
  • Add a Prescription Drug Plan if you return to Original Medicare.

It’s important to keep in mind that the MA-OEP is only for people who already have a Medicare Advantage plan. If you change plans during the MA-OEP, your new coverage will be effective on the first day of the month after you enroll.

How Do Medicare Advantage Plans Work?

Medicare Advantage health care plans work like the employer-sponsored health insurance plans you may be used to from your previous or current job.

Medicare Advantage plans provide comprehensive coverage, and you usually need to stay in-network to receive care. You’ll typically have some out-of-pocket expenses when you receive services and procedures under your Medicare Advantage policy. These costs typically come in the form of copayments or coinsurance that you’ll pay to your provider when you receive care.

An important point to remember is that all Medicare Advantage plans have an annual out-of-pocket (OOP) maximum that limits the total amount you can spend in any year. But you do not have an OOP with Original Medicare.

What is the Difference Between Original Medicare and Medicare Advantage Plans?

The primary difference between these programs is that Medicare Advantage is an alternative to Original Medicare. When you join a Medicare Part C plan, you no longer receive your Medicare benefits through Original Medicare.

Medicare Advantage plans are offered and administered by private insurance companies. But these private insurance companies must comply with many rules and regulations set by the Medicare program.