Medicare Advantage - 2012 Guide To Medicare Advantage plans(Medicare Part C)
Are you asking yourself questions such as, "What is Medicare Advantage?" How about, "What should I know about Medicare Advantage plans in 2012?" You have certainly come to the right place. Welcome to eHealth Medicare's 2012 Medicare Advantage (Medicare Part C) guide. Here, we highlight the most important topics to think through as you review your Medicare options. After reading this article, you will have a solid understanding of Medicare Advantage plans and what you need to know in 2012.
Medicare Advantage (Medicare Part C) Defined
Before jumping into our 2012 guide, let's first define Medicare Advantage. Medicare Parts A and B (Original Medicare) are offered by the government. By contrast, Medicare Advantage (Medicare Part C) is offered by private insurance companies. Medicare Advantage plans must provide coverage equivalent to Medicare Parts A and B (by law). However, most Medicare Advantage plans offer benefits above and beyond Parts A and B while many also include Medicare Part D prescription drug coverage. In short, most Medicare Advantage Plans package together many of the benefits of Medicare Part A, Medicare Part B, Medicare Supplemental Insurance (Medigap), and Medicare Part D (Prescription Drug Coverage) - all in one convenient plan.
Medicare Advantage Plans - Important Points To Remember
Now that we've defined Medicare Advantage, let's jump into our 2012 guide. In particular, we will cover the following topics in today's guide:
1. Annual Enrollment Period (AEP) Dates
2. Star Ratings and Special Election Period (SEP)
3. Convenient Medicare Advantage Bills
4. Affordable Monthly Premiums
8. Getting Prepared For Baby Boomers
Annual Enrollment Period (AEP) Dates For 2011-2012
What is the Annual Enrollment Period (AEP)? This is the time each year when most Medicare beneficiaries are able to change their Medicare Advantage or Medicare Part D coverage. Of particular importance, the Annual Enrollment Period (AEP) is changing this year. While AEP spanned November 15, 2010 to December 31, 2010, AEP shifted earlier this year and spans October 15, 2011 to December 7, 2011. What if you're already on a Medicare Supplement Plan (Medigap) but wish to switch to a Medicare Advantage plan? AEP is the time period when you can make the switch. If you have a qualifying event, you may be able to make changes outside of this period as well. It's important to stay on top of these dates because this is your window to make changes in your Medicare coverage.
Medicare Advantage Star Ratings and Special Election Period (SEP)
Beginning in 2012, The Affordable Care Act (health reform) requires a star rating system to be used for Medicare Advantage plans. Ratings span 1 to 5 stars with 5 being the best. Leveraging this star rating system, there now exists a Special Election Period (SEP) for 5-star Medicare Advantage Plans. Specifically:
- SEP begins December 8, 2011, that is, the day after the end of the Fall 2011 AEP, which will be December 7.
- For purposes of the SEP, a Medicare Advantage plan must have 5 stars as of the 2011 Annual Enrollment Period (AEP).
- The new SEP will apply only for purposes of enrolling in a 5-star Medicare Advantage (MA) plan; it will not permit an individual to enroll in 5-star stand-alone Part D, 1876, 1833 or any other Medicare health plan other than a Medicare Advantage plan.
- Individuals will be eligible for this SEP only if they are either currently enrolled in MA plans with a star rating of 4.5 or less, or enrolled in Original Medicare and meet the MA eligibility requirements. Individuals already enrolled in 5-star MA plans are not eligible for the SEP.
- Once an individual enrolls in a 5-star MA plan, the individual's SEP ends for that plan year, and the individual will be limited to making changes only during other applicable election periods (e.g., annual enrollment period, other valid election period, or another valid SEP).
Convenient Medicare Advantage Bills
Where you're managing your personal finances, fewer bills and the need for writing fewer checks are always beneficial. One of the benefits of Medicare Advantage plans is ease of billing. You'll get one bill and only have to write one check each month, as opposed to separate checks for drug coverage and medical coverage (if you go the Medigap and Medicare Part D route). Many Medicare Advantage plans include Medicare Part D coverage, known as MAPD plans. (However, if you'd prefer separate Medicare Advantage and Medicare Part D policies, that option is available as well.) Medicare Advantage means simplicity in 2012.
Medicare Advantage Plans Offer Affordable Monthly Premiums
Given all of the advantages of Medicare Advantage plans, you may be thinking that such plans carry high monthly premiums. Surprisingly, the average enrollment-weighted MA monthly premium in 2011 is around $43 (according to the Kaiser Family Foundation*). In fact, some MA plans are available at zero additional monthly premium compared to Medicare Pars A and B (original Medicare). In short, Medicare Advantage (Part C) plans offer affordable monthly premiums.
* Source: http://www.kff.org/medicare/8117.cfm
Out-of-Pocket Limits Offer Peace of Mind
Health reform, via The Affordable Care Act, requires that Medicare Advantage plans limit how much customers can pay out of their own pocket (excluding the cost of prescription medications). Precisely, the maximum out-of-pocket expenses for 2011 were capped at $6,700. By comparison, original Medicare (Medicare Parts A and B) offer no out-of-pocket caps. Medicare Advantage plans make it easier to sleep at night with this out-of-pocket peace of mind.
Added Benefits of Medicare Advantage Plans
Oftentimes, Medicare Advantage plans offer additional benefits such as routine vision coverage, routine dental care, audiology services, and even fitness classes. Moreover, many MA plans include the Medicare Part D prescription drug benefit, known as MAPD plans.
Variable Plan Types: HMO, PPO, PFFS, and SNPs
Historically, Medicare Advantage plans were available primarily as HMO plans. This means medical services were provided through a specific network of doctors and hospitals that then often required referrals to see a specialist. Now, Medicare Advantage plans come in these other variable plan types as well, offering you more options:
- Preferred Provider Organizations (PPO) - offering a wider choice of providers
- Private Fee-for-Service (PFFS) plans - typically don't have networks
- Special Needs Plans (SNP) - designed for individuals with lower incomes and/or specific diseases/conditions
Getting Prepared For Baby Boomers
We'd like to close out today's 2012 Medicare Advantage guide with the advice that it's a prudent idea to make a plan and review your Medicare coverage options early. This year, baby boomers begin turning 65. That means more people will be enrolling in Medicare (and Medicare Advantage plans) this year than in the past. Licensed agents who assist with Medicare plan enrollment will be busier than ever. Coupled with the new AEP enrollment dates, it's a prudent decision to begin your planning early.
eHealth Medicare - The Destination for Medicare Help and Guidance
So there you have it - The top points to consider when evaluating your Medicare Advantage options in 2012. As a closing note, we encourage you to leverage eHealth Medicare to research, compare, and plan your Medicare Advantage needs. We offer free, no obligation articles with Medicare information in addition to plan comparison. Find coverage today. Additionally, you may wish to research Medicare by visiting www.medicare.gov, calling 1-800-Medicare, or visiting your local Medicaid office.
