Medicare

Are You Taking Full Advantage of Your Medicare Plan?

October 15, 2020 • By

Reading Time: 2 Minutes

Last Updated: July 19, 2021

Medicare is our country’s health insurance program for people age 65 or older, and for younger people receiving Social Security disability benefits. It helps with the cost of health care, but doesn’t cover all medical expenses or the cost of most long-term care.

You have choices for Medicare:

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • Medicare Advantage (also known as Part C).
  • Medicare Part D (prescription drug coverage).

If you have Original Medicare, the government pays for Medicare benefits when you get them. You can add prescription drug coverage to help pay for costs that Original Medicare doesn’t cover.

Medicare Advantage Plans are offered by private companies approved by Medicare. These “all in one” alternatives to Original Medicare include Part A, Part B, and usually Part D (prescription drug coverage). Medicare Advantage Plans may have lower out-of-pocket costs than Original Medicare. They may also offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more.

How you qualify

You can enroll in a Medicare Advantage Plan, if you have Part A and Part B and reside in the plan’s service area. Please be aware there are some restrictions if you have End-Stage Renal Disease. The most common types of plans are:

Before you join a Medicare Advantage Plan:

  • Find and compare Medicare health plans in your area using Medicare’s Plan Finder.
  • Visit the plan’s website to see if you can join online.
  • You can also call Medicare at 1-800-MEDICARE (1-800-633-4227). When you call, please have your Medicare number and the date your Part A or Part B coverage started. You can find this information on your Medicare card.

When can I join, switch, or un-enroll in a Medicare Advantage Plan?

  • Initial Enrollment Period. When you first become eligible for Medicare, you can join a Medicare Advantage Plan during your Initial Enrollment Period.
  • General Enrollment Period. If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan at that time. Your coverage may not start until July 1.
  • Open Enrollment Period. From October 15 – December 7 you can join, switch, or un-enroll in a Medicare Advantage Plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

You can learn more about Medicare, including how to apply for Medicare and get a replacement Medicare card, by reading our publication Medicare. You can also visit our website.

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About the Author

Darlynda Bogle, Assistant Deputy Commissioner

Darlynda Bogle, Assistant Deputy Commissioner

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Comments

  1. Gisela R.

    I’ll be 65 in November, I’m single and get 1,008.00 a month from S.S. I have Medicaid and Medicare starts in November. My problem is that Medicare is going to charge me 140.60 each month for Part B.
    There’s no way I can afford that what can I do.
    Can I cancel Part B?

    Thank you

    • V.V.

      Hi Gisela, thanks for using our blog. You may want to apply for Extra Help with Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. In addition to the Extra Help, you may be able to get help from your State with other Medicare costs under the Medicare Savings Programs. By completing the Extra Help application, you will start your application process for a Medicare Savings Program. We will send information to your State who will contact you to help you apply for a Medicare Savings Program unless you tell us not to when you complete the application.

      If you need information about Medicare Savings Programs, Medicare Prescription Drug plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit http://www.medicare.gov. You also can request information about how to contact your State Health Insurance Counseling and Assistance Program (SHIP). The SHIP offers help with your Medicare questions. We hope this helps.

  2. Gary W.

    I change from well care to Humana, because we’ll care didn’t pay everything ,I would have to call them off and on to see why, humana, is been a great big change and give so much more

  3. Joanne S.

    Medicare advantage is a way the government takes money from Medicare and gives it to their friends in the private insurance company, rather than pay for the services directly out of medicare. Its a way to give money to private companies, Which is more expensive to taxpayers than if it were paid directly by medicare. They are dying to privatise our Medicare

  4. Candice

    Is there a way to not be enrolled in Medicare I have other coverage

    • V.V.

      Hi Candice, thanks for using our blog. Check out our Frequently Asked Questions web page for details on how to terminate Medicare Part B. We hope this helps!

  5. z L.

    z

  6. John A.

    I’m 63 years old and will be 64 in January what mo should I sign up for medical insurance? Ps my wife is on my insurance right now but is Disable do we both sign up at the same time?

    • V.V.

      Hi John, thanks for using our blog. Check out our Frequently Asked Questions web page for details on when and how to sign up for Medicare. We hope this helps!

      • BETTY G.

        so disappointed that you do NOT answer anyone’s specific questions asked of you.

        you give them a link only where you could use your EXPERTISE to help them.

        just my observations on seeing the same form letter with a different link for each reply you do.

  7. Mary H.

    how do you get into one of these plans. how do you find out about who has these plans. what is the dountnut whole in your presprection plan. what are the different prescreption plan. what is the big amount that5 you have to pay for at the beginning of the year too the drug store. can you use coupons too reduce the price it you can find them from the drug company,

    • V.V.

      Hi Mary, thanks for using our blog. If you need information about Medicare Savings Programs, Medicare Advantage Plans, Medicare Prescription Drug plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit http://www.medicare.gov. You also can request information about how to contact your State Health Insurance Counseling and Assistance Program (SHIP). The SHIP offers help with your Medicare questions. We hope this helps.

    • Kay

      Mary,
      Go to Medicare.gov to see what Part D prescription drug plans are available in your area. There is a series of questions they will ask you–what type of plan are you interested in (Medigap, Advantage, drug plan), your zip code, etc. The plans available in your zip code will come up. You can add your medications and favorite pharmacies, and the program will tell you total estimated drug costs for the year based on your current medications. The total includes the monthly Part D premiums, the deductible, and your estimated medication costs. In my area there are 20+ Part D plans available, and Medicare arranges them starting with the least expensive one.
      Part D drug plans have a deductible. The maximum deductible in 2020 is $435. Most plans require you to pay the full deductible amount before they will start to kick in, but some of the plans will have less of a deductible. You will need to review the plans in your area to see what portion of the deductible they will cover, if any.
      The donut hole is a coverage gap in a Part D plan. For 2020, after you and your plan pay $4020 for your prescription drugs, the coverage gap begins and you are responsible for 25% of the cost of your drugs. After you have paid $6350 (in 2020) out of your own pocket for the year, the donut hole ends and catastrophic coverage begins. At that point you pay 5% of the cost of your drugs or a minimum set amount, whichever is greater.
      If you use a coupon from Good Rx or another similar program, you may be able to get the drugs for less money. However, it is my understanding that what you pay will not be included in the Part D total costs for determining whether you have met your deductible or donut hole requirements. Ask your pharmacist about this.
      I am no expert and do not represent myself as an authority on these matters. I am only telling you what my understanding is and what I have gleaned from doing my own research. I encourage you to go to the Medicare.gov site or to call your state’s SHIP office for more information. But I hope this helps.

  8. David J.

    Is this Medicare Advantage plan a part of Social Security? How much does it cost each month?
    Every time I ask somebody about what is the best plan to get to cover what Medicare doesn’t cover; I never have been able to get an answer to that question..
    I have Silver Script & it is starting to cause some kind of financial
    Do you know everything aboutS.C.A.N. ?

    I am basically homeless. That $100 that is taken out of my medicare every month really hurts cuz I don’t make that much
    Thank you very much

    • V.V.

      Hi David, thanks for using our blog. If you need information about Medicare Advantage Plans, Medicare Prescription Drug plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit http://www.medicare.gov. You also can request information about how to contact your State Health Insurance Counseling and Assistance Program (SHIP). The SHIP offers help with your Medicare questions. We hope this helps.

  9. Kay

    This is a very slanted article. It barely mentions traditional Medicare and does not mention at all Medigap plans that can cover the costs of almost all services not covered by traditional Medicare, depending on the Medigap plan chosen. Please be aware that if you choose Medicare Advantage plans, your doctor/hospital/lab network will be limited and you will probably need a referral to see specialists. You will probably have higher out of pocket costs because of copays. And your network may be limited to your geographic area–so if you are traveling, you may not be covered unless you are having an emergency, and the definition of an emergency and follow up care may be fuzzy.
    Also, if you choose and Advantage plan and then decide you don’t like it, you can switch back to traditional Medicare but may not be able to find a Medigap plan that will take you, or if they do they can charge you more for pre-existing conditions. The best time to sign up for Medigap is within 6 months of the time you have registered for Medicare Part B. During those 6 months Medigap plans have to take you no matter what your health status is and cannot charge you more than anyone else your age–in other words, the Medigap plans are guarantee issue during those 6 months. If you are past those 6 months, they do underwriting, which means they can ask you questions about your health and check into your past claims, and they may deny you coverage or charge you more for it.
    This article should have covered all those facts about the differences between Medicare Advantage and traditional Medicare with a Medigap plan. It is misleading not to do so. And people need to do their own research and not trust SS, TV ads, Insurance commpanies, or anyone else with an agenda.

    • Gerald

      Thanks for the info. You really can not trust anything or anybody nowadays.

  10. Derek S.

    I didn’t realize that you can only enroll in a Medicare Advantage Plan if you live near the plan’s service area. I remember my grandfather mentioning how he plans on moving to another state after he retires next month, and he would like to make sure that he can find some affordable insurance that he will be able to afford with his monthly retirement fund. He should think about looking over his options in order to get the right coverage.
    https://myseniorhealthplan.com/medicare-plans/how-to-get-medicare/

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