Is it necessary to first enroll in Medicare Part B before signing up for a Medicare Advantage plan? In brief, the answer is yes. The Medicare Advantage plan, often referred to as Medicare Part C, allows Medicare beneficiaries to obtain their Medicare Part A and Part B benefits through a Medicare Advantage plan rather than directly through the government-operated Medicare program.

Medicare Advantage complements rather than replaces Original Medicare Part A and Part B coverage. Instead of directly receiving these benefits through the government, Medicare Advantage delivers them through private insurance companies that have contracts with Medicare. These private insurance companies offering Medicare Advantage plans are required to provide, at a minimum, the same benefits as those available under Original Medicare except for hospice care, which remains covered by Part A. In addition, many Medicare Advantage plans offer additional benefits that are not part of Original Medicare. To be eligible for a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Medicare Part B, and you must also live within the service area of the specific plan you wish to enroll in.

When to Enroll in Medicare Benefits

Your Initial Enrollment Period (IEP) marks your first opportunity to sign up for Original Medicare, which includes Part A and/or Part B. This enrollment window commences three months before you satisfy all the eligibility prerequisites for Medicare and stretches out over a seven-month duration.

If you wish to enroll in a Medicare Advantage plan, you must meet the criteria for Medicare Part A entitlement and be currently enrolled in Medicare Part B. The Medicare Open Enrollment Period, which transpires annually from October 15 to December 7, permits you to make alterations to your Original Medicare coverage, such as joining, switching, or discontinuing it.

In case you delayed enrolling in Medicare Part B due to residing abroad or having coverage through an employer-provided group health plan, you have the option to enroll in Medicare Part B during a Special Election Period upon your return to the United States or upon the termination of your group health coverage. During this period, you might also have the opportunity to sign up for a Medicare Advantage plan.

Is it possible to discontinue my Medicare Advantage Plan and return to Original Medicare (Part A and Part B)?

Absolutely, you have the flexibility to join a Medicare Advantage plan, change your plan, or revert to Original Medicare. Additionally, if you so desire, you can opt for a separate Medicare Part D Prescription Drug Plan to complement your Part A and Part B coverage. This transition can be made during the Annual Election Period (AEP), which falls between October 15 and December 7 each year.

For those who are already enrolled in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period is available from January 1 to March 31 annually. It’s important to bear in mind that you can switch plans only once during this window. During this timeframe, you can:

• Transfer to a different Medicare Advantage Plan, either with or without prescription drug coverage.
• Discontinue your Medicare Advantage Plan and return to Original Medicare. You also have the option to enroll in a Medicare Advantage Prescription Drug Plan.

However, during the Medicare Advantage Open Enrollment period, you cannot:

• Transition from Original Medicare to a Medicare Advantage Plan.
• Enroll in a Medicare Advantage Prescription Drug Plan if you are currently on Original Medicare.
• Switch from one standalone Medicare Part D prescription drug plan to another if you are currently on Original Medicare.

Costs Associated with Medicare Advantage

Medicare disburses a set monthly amount to insurance companies offering Medicare Advantage Plans to cover your healthcare expenses. Expenses linked to Medicare Advantage plans can fluctuate, with varying out-of-pocket costs depending on the specific plan. These plans may also impose distinct regulations pertaining to the manner in which you access services, including:

• The requirement for a referral before seeing a specialist.
• The need of utilizing healthcare providers, facilities, or suppliers affiliated with the plan for non-emergency or non-urgent care.

In most instances, you’ll be required to seek healthcare services from providers within the plan’s designated network. Some plans may not provide coverage for services offered by providers outside of their network or service area. 

It’s important to note that Medicare Advantage plans come with an annual cap on your out-of-pocket expenses for all Part A and Part B services. Once this limit is reached, you won’t be responsible for any costs related to the services covered by Medicare Part A and Part B.

Regarding Medicare Part B premiums, it’s essential to continue paying them while enrolled in a Medicare Advantage plan. Additionally, you are expected to fulfill any monthly premium obligations associated with your specific Medicare Advantage plan.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.