As they were originally designed back in 1965, Medicare programs consist of Part A, hospital insurance, and Part B, medical insurance, and runs as a “fee-for-service” system. Under this program, a Medicare beneficiary can go to any health care provider that accepts Medicare payments.
In 1997, as an alternative to Medicare Parts A and B, the federal government created Medicare Part C, the Medicare+Choice, program. It was designed to give Medicare beneficiaries more choices, including a wide variety of more cost-effective, private health plan choices. In 2003, as part of the Medicare Prescription Drug, Improvement, and Modernization Act, Medicare+Choice was renamed “Medicare Advantage.”
Medicare Advantage Options:
Generally, Medicare beneficiaries are entitled to choose either the original fee-for-service Medicare Parts A and B or a Medicare Advantage plan.;
The Medicare Advantage options include:
Health maintenance organizations (HMOs)
Point-of-service (POS) plans
Preferred provider organizations (PPOs)
Provider sponsored organizations (PSOs)
Private fee-for-service plans.
Medicare Advantage Benefits:
With the exception of hospice care, Medicare Advantage plans provide the same benefits as those in the traditional fee-for-service plan. The plans can offer supplemental benefits not covered by the traditional plan. Medicare Advantage plans can’t deny or limit coverage based on health-status factors, with one exception, end-stage renal disease.
Choosing your plan:
Once you decide on a plan, that choice remains in effect until you change it or the plan you chose no longer services the state where you live. If you don’t decide, you will stay in the traditional fee-for-service program.
Initial Medicare eligibility:
When you first become eligible for Medicare benefits and have enrolled in a Medicare Advantage plan, you can change to the fee-for-service plan anytime during your first 12 months of enrollment. You will have an extended period of guaranteed access to Medigap plans during this time.
Enrollment periods take place each year in November. Elections take effect January 1 of the following year. As part of your enrollment, you will be given information about every health plan available to you. You can make an informed health care choice by comparing the quality and performance data included in this information.
Special enrollment periods:
After the end of the continuous open enrollment, special enrollment periods are available if:
A plan is discontinued,
;the plan violates its contract with Medicare, or
;you have exceptional conditions that are specified in the regulations.