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What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a plan provided by private insurance companies contracted by Medicare to fulfill the basic coverages of Original Medicare. Many plans come with additional benefits. 

These additional benefits can sometimes be provided at no additional cost to you. This is possible because Medicare actually pays the insurance company for providing your healthcare coverage. 

When Can I Enroll in Medicare Advantage?

There are specific times in which you can enroll in a Part C plan:

Initial coverage election period — Your initial coverage election period is a seven-month period that starts 3 months before the month you turn 65 and ends 3 months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll into an Advantage plan three months before your month of eligibility until three months after you became eligible. 

Annual election period — This is known as open enrollment or AEP, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the Part C (Medicare Advantage) plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — The Open Enrollment Period, or OEP, is January 1 through March 31 every year. During this open enrollment period from, you are able to change from one Advantage plan to another or drop it to return to Original Medicare. However, if you are not already enrolled in a plan, you cannot enroll at this time.

Special Election Period — If a beneficiary has a qualifying event, they are entitled to a Special Election Period, or SEP. There are multiple events that can trigger a special election period. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period.


For example, a SEP can be trigged if you move outside your plan's coverage area or if you qualify to Extra Help (a program that helps pay for your prescription drugs). During this time you can make changes to your Advantage plan or return back to Original Medicare.

There are several common Special Election Periods that many beneficiaries have, but few actually know they have it. You can speak with the brokers at Medicare Policy Experts to find out if you have a Special Election Period.

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Medicare Advantage Eligibility

To be eligible for Medicare Advantage, you must be eligible for Medicare Part A and enrolled in both Medicare Part A and Medicare Part B. If you drop Medicare Part B, you will lose your Medicare Advantage Plan.


There are specific times where

you can enroll in Part C

Benefits of Medicare Advantage

Medicare Advantage, Part C, plans are required by Medicare to provide at least the same benefits of Parts A and B. This includes inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care, outpatient care, medical equipment, and some preventative services. 

However, Advantage plans can provide additional benefits like: 

  • No Cost to Low Cost Plans

  • Prescription Drug Coverage

  • Dental

  • Vision

  • Adult day-care services

  • Fitness memberships

  • Hearing

  • Nutrition programs

  • Over-the-counter drugs

  • Services and supports for those with chronic conditions

  • Transportation to doctor visits

  • Wellness programs

The benefits you are eligible for will depend on your area and the plan providers.

Medicare Advantage Special Needs Plans

Medicare Advantage Special Needs plans are a set of Medicare Advantage plans that serve individuals with unique needs. 

There are three types of Special Needs plans:

  • Chronic-Condition Special Needs Plan — This plan is for Medicare beneficiaries with disabling chronic conditions such as certain autoimmune diseases, cancer, end stage rental disease (ESRD), cardiovascular disorders, dementia, HIV/AIDS, and other chronic conditions.

  • Dual-Eligible Special Needs Plan — This plan is for those who have both Medicare and Medicaid benefits.

  • Institutional Special Needs Plan — This plan is for those who live in an institution, like a nursing home, or who require nursing care at home.

Special Needs plans include care-coordination services specific to your chronic condition. Services such as wellness plans to help you understand and follow your special diet or other activities that help improve or manage your condition. You may also have access to doctors or hospitals that specialize in your chronic condition. 

If you think you qualify for one of these plans and want to be sure of your eligibility, reach out to use at the Medicare Policy Experts. We'll help you determine your eligibility and provide a free, no obligation quote.

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