Individuals in Massachusetts who are already enrolled in Original Medicare Part A and Part B qualify to enroll in Medicare Part C, popularly known as Medicare Advantage. Private insurance companies offer Medicare-approved Part C plans as an alternative way of getting Medicare Part A and Part B benefits. Basically, Medicare Part C provides similar coverage as Original Medicare. However, it may also offer extra benefits, including a cap on maximum out-of-pocket expenses and coverage for hearing aids, and some dental and vision services, as well as prescription drugs.
Medicare Advantage Plans Available in Massachusetts
There are several Part C plans available to those who are enrolled in Original Medicare. The following are some of the common types:
Health Maintenance Organizations (HMOs) – This plan allows you to select providers from a network. However, a referral from a primary care doctor for specialty care is a requirement. This is the ideal option for a beneficiary whose doctor is already part of the network because there will be fewer out-of-pocket expenses.
Preferred Provider Organizations (PPOs) – You have a choice to get medical care outside the network. But, this may mean that you have to pay more for such medical services. With this option, a referral letter to consult with a specialist is not a strict requirement.
Private Fee-for-Service (PFFS) plan – Payment rates are set by this plan and not Medicare. So the plan determines how much you will pay for things such as doctor’s visits and how much those doctors will be paid. This plan only works if the doctor treating you agrees to the payment terms.
Prescription Drug Coverage
One of the advantages of enrolling in a Medicare Advantage plan is that most plans provide coverage for prescription drugs. The plans are called Medicare Advantage Prescription Drug plans (MAPD). Because ageing brings many chronic, age-related illnesses, comprehensive drug cover is a necessity.
Enrolling in a Medicare Advantage Plan
Enrolling in a Medicare Advantage plan has to be done during specified periods:
The Initial Coverage Election Period
You can enroll in a Medicare Advantage plan when you first qualify for Medicare. The Initial Coverage Election Period lasts 7 months, and it begins 3 months before you turn 65 years, includes your birthday month, then ends 3 months after you have turned 65 years.
Annual Election Period
The Annual Election Period starts on October the 15th and ends on December the 7th each year. The plan you opt for during this period begins the following year on January the 1st.
Medicare Advantage Open Enrollment Period
In the event that you change your mind after signing up for a Medicare Advantage Plan, you are allowed to go back to Original Medicare between January 1 and March 31. If that switch results in you losing prescription coverage, you can always sign up for a stand-alone Medicare Prescription Drug Plan (Part D).
Medicare Advantage Plans in Massachusetts are for people who are looking for additional benefits, which Original Medicare does not offer. These benefits include dental services, prescription drugs, and hearing and vision care.