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Do I have to be enrolled in Medicare Part B before I enroll in a Medicare Advantage plan?




Summary:

When it comes to your Medicare Advantage plan, do you have to be enrolled in Medicare Part B first? In short, yes. The Medicare Advantage program (also known as Medicare Part C) provides the means for Medicare beneficiaries to receive Medicare Part A and Part B benefits from a Medicare Advantage plan rather than from the government-administered Medicare program.


Medicare Advantage doesn’t replace Original Medicare Part A and Part B coverage; it simply delivers these benefits through an alternative channel: private insurance companies. Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Medicare Advantage plans must offer at least the same benefits as provided under Medicare Part A and Part B (with the exception of hospice care, which continues to be covered by Part A). Many Medicare Advantage plans offer extra benefits not available from Original Medicare. Therefore, to enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Medicare Part B. You must also reside in the plan’s service area.


When to enroll in Medicare benefits

The Initial Enrollment Period is the first chance you have to enroll in Original Medicare, Part A and/or Part B. Your Initial Enrollment Period starts three months before you first meet all the eligibility requirements for Medicare and lasts for seven months.


To enroll in a Medicare Advantage plan, however, you have to be entitled to Medicare Part A and enrolled in Medicare Part B. You can join, switch or drop your Original Medicare coverage during the Medicare Open Enrollment Period that runs from October 15 – December 7 each year.


If you delayed enrollment in Medicare Part B because you lived abroad or had insurance coverage through an employer-sponsored group health plan, for example, you may enroll in Medicare Part B during a Special Election Period when you return to live in the United States or your group health coverage ends. You may be able to enroll in a Medicare Advantage plan at this time, as well.


Can I drop my Medicare Advantage Plan and go back to Original Medicare (Part A and Part B)?


Yes, you may enroll in Medicare Advantage plan, change plans, or return to Original Medicare and, if you choose, sign up for a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Part A and Part B coverage during the Annual Election Period (AEP), which occurs from October 15 to December 7 of each year.

If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year. It is important to note that you can only switch plans once during this time. During this period you can:

  • Switch to another Medicare Advantage Plan with or without prescription drug coverage.

  • Drop your Medicare Advantage Plan and go back to Original Medicare. You can also enrolling in a Medicare Advantage Prescription Drug Plan.

What you can’t do during the Medicare Advantage Open Enrollment period is

  • Switch from Original Medicare to a Medicare Advantage Plan.

  • Enroll in a Medicare Advantage Prescription Drug Plan if you’re in Original Medicare.

  • Switch from one stand-alone Medicare Part D prescription drug plan to another if you’re in Original Medicare

Medicare Advantage costs

Medicare pays a fixed amount for your care each month to insurance companies that offer Medicare Advantage Plans. Medicare Advantage plan costs may vary from plan to plan and can charge different out-of-pocket costs. Plans can also have different rules for how you get services such as:

  • Whether you need a referral to see a specialist.

  • If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care.

In most cases, you’ll need to use health care providers who participate in the plan’s network. Some plans won’t cover services from providers outside the plan’s network and service area. Medicare Advantage plans do have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, you’ll pay nothing for the services that Medicare Part A and Part B cover.


Do you have to pay Medicare Part B premiums with a Medicare Advantage plan?


Yes, you must continue paying your Medicare Part B premium, along with any monthly premium charged for your Medicare Advantage plan.

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