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Taking the Confusion out of Medicare
Medicare Advantage Plans
Medicare Advantage (MA) plans, also known as Medicare Part C, are private health insurance options offered to individuals eligible for Medicare (typically those aged 65 and older) in the United States. These plans are provided by private insurance companies approved by Medicare and offer an alternative way to receive Medicare benefits, instead of the traditional Original Medicare (Part A and Part B).
MA plans must cover all the services that Original Medicare covers, but they can also include additional benefits, such as prescription drug coverage (Medicare Part D), vision, dental, hearing, fitness programs, and more. Some MA plans may have lower out-of-pocket costs than Original Medicare, making them an attractive option for many beneficiaries.
History of Medicare Advantage Plans
The Medicare Advantage program was established in 1997 as part of the Balanced Budget Act. It aimed to offer more choices to Medicare beneficiaries by allowing private insurance companies to compete with the government-run fee-for-service Medicare program. Over the years, the popularity of Medicare Advantage plans has grown significantly, with millions of beneficiaries now enrolled in these plans.
Things you need to know
Initial Enrollment Period (IEP)
Initial Enrollment Period (IEP)
Initial Enrollment Period (IEP)
The Initial Enrollment Period is the first opportunity for individuals to sign up for Medicare Advantage plans. It occurs when someone first becomes eligible for Medicare, which is typically around their 65th birthday. The IEP lasts for seven months, starting three months before the month of their 65th birthday, including their birthday month, and continuing for three months after that.
Annual Enrollment Period (AEP)
Initial Enrollment Period (IEP)
Initial Enrollment Period (IEP)
The Annual Enrollment Period, also known as the Fall Open Enrollment Period, takes place every year from October 15th to December 7th. During this time, Medicare beneficiaries can review and make changes to their Medicare coverage. This includes switching from Original Medicare to a Medicare Advantage plan or vice versa, changing between different Medicare Advantage plans, or enrolling in or dropping prescription drug coverage (Medicare Part D).
Open Enrollment Period (OEP)
Initial Enrollment Period (IEP)
Special Enrollment Period (SEP)
The Open Enrollment Period, which is sometimes confused with the Annual Enrollment Period, occurs from January 1st to March 31st each year. During this period, individuals who are already enrolled in a Medicare Advantage plan can make one change to a different Medicare Advantage plan or return to Original Medicare with or without a standalone Part D plan.
Special Enrollment Period (SEP)
Special Enrollment Period (SEP)
Special Enrollment Period (SEP)
A Special Enrollment Period allows certain individuals to make changes to their Medicare Advantage or prescription drug coverage outside of the usual enrollment periods. SEPs are triggered by specific life events, such as moving to a new area with different Medicare plan options, losing other health coverage, or qualifying for extra help with prescription drug costs.
AHIP Certification
Special Enrollment Period (SEP)
AHIP Certification
AHIP stands for the America's Health Insurance Plans, a trade association representing health insurance providers. AHIP offers a certification program for insurance agents and brokers who wish to sell Medicare Advantage and Medicare Part D plans. The Centers for Medicare & Medicaid Services (CMS) requires agents to complete AHIP's training and pass the certification exam before they can market and sell Medicare Advantage and Part D plans to beneficiaries.
The AHIP certification covers various aspects of Medicare, plan options, enrollment periods, marketing guidelines, compliance regulations, and more. It ensures that agents have a solid understanding of the Medicare program and can provide accurate and helpful information to beneficiaries when assisting them with plan selection.
Medigap Plans
Special Enrollment Period (SEP)
AHIP Certification
Medigap plans, also known as Medicare Supplement plans, are private health insurance policies designed to complement Original Medicare (Part A and Part B). They help cover the "gaps" in Medicare coverage, such as deductibles, copayments, and coinsurance. These plans are offered by private insurance companies and are regulated by both federal and state laws.