Medicare Advantage Plans are also called Medicare Part C or MA Plans. Medicare Advantage Plans are run by private insurance companies and replace Medicare Parts A and B. They sometimes include additional benefits such as dental and vision coverage and in most cases provide prescription drug coverage, more commonly known as an MA-PD.

Beneficiaries who enroll in MA and MA-PD Plans generally get all of their healthcare services through the insurance plan. Members must continue to pay their Part B monthly premium.

Medicare Advantage members must pay a premium for this coverage, except in the case of a Medical Savings Accounts (MSAs).

There are 3 types of MA Plans:

1. Coordinated Care Plans (CCPs), including:
   • - Health Maintenace Organizations (HMOs)
   • - Perferred Provider Organizations (PPOs)
   • - Special Needs Plans (SNPs)
2. Private Fee-for-Service (PFFS) plans
3. Medical Savings Accounts (MSAs)

For most Medicare beneficiaries in 2010, the MA Plan of choice is the PFFS Plan. Available in most states, a Private Fee-for-Service Plan requires:

• Members can see any doctor in any service area provided the provider accepts the Plan’s terms and conditions in advance unless an emergency.
• Members do not need a referral to see a specialist
• Medicare pays a set amount every month to the health plan for the member’s care
• Plan determines how much members must pay for care
• Plan covers Part A and Part B services
• Plan usually covers Part D prescription drug coverage
• Additional benefits may be included

Enrollment Periods:

ICEP (Intial Coverage Election Period)

• The Initial Coverage Election Period (ICEP) is the one-time period when an idividual may first request to enroll in an MA plan.
• This period occurs 3 months before an individual is entitled to both Medicare Part A and B. It ends on either the last day of the month before his/her entitlement to Part A and B or the last day of his/her Part B Initial Enrollment Period (whichever is later).
• The Part B Initial Enrollment Period occurs 3 months before the month the individual turns 65 until 3 months after the month he/she turns 65.
• If a member chooses not to enroll in an MA plan during their Initial Enrollment Period then his/her ICEP will begin 3 months before the individual’s effective Part B enrollment date.

AEP (Annual Enrollment Period)

• The period from November 15 – December 31 whereby a Medicare beneficiary can change health and/or prescription drug coverage. Coverage begins January 1.

MADP (MA 45 Day Disenrollment Period)

• The Affordable Care Act, passed in 2010, created the MADP and eliminated the “Open Enrollment Period.”
• Who is eligible for the MADP?
  All MA or MA-PD enrollees
• When does the MADP take place?
  From January 1 – February 14 of each year
• What can beneficiaries do during MADP?
  MA and MA-PD enrollees may request disenrollment from their plan and return to Original Medicare and subsequently may enroll in a PDP or may simply request enrollment in a PDP, resulting in automatic disenrollment from the MA plan. (Exception: MA-only PFFS must request disenrollment first.)

SEP (Special Enrollment Period)

• Varies depending upon Medicare beneficiaries circumstance. Examples of an SEP include leaving a group plan voluntarily or involuntarily or leaving the service area. Coverage begins the 1st of the month following the SEP.

Scope of Appointment Forms

CMS requires a Medicare beneficiary to confirm either in writing or using Voice Vault an appointment. The Scope of Appointment Form asks which plan(s) you would like our agents to discuss.

A Scope of Appointment form available for download here.

Compensation

Our agents are compensated by the insurance carrier we recommend. CMS prohibits an agent from charging any administrative or consultation fees.

Source: Centers for Medicare and Medicaid Service (CMS) and CSA Basics