Blue cross blue shield of new mexico medicare advantage

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Medicare Advantage (Part C)

Medicare Advantage plans provide Medicare coverage through private health insurance companies approved to participate in the Medicare program. These plans can be HMOs, PPOs, Regional PPOs or Private Fee-for-Service plans.

Medicare Advantage plans provide all Part A and B services while generally including some additional services, such as wellness programs, hearing aids and vision services. These plans also tend to have lower cost sharing overall and a maximum that you would have to pay for out-of-pocket costs each calendar year–a feature not available through Original Medicare.

Costs

Limits and Considerations

Limits

Medicare Advantage plans have defined geographic service areas and most have networks of physicians and hospitals where you can receive care. Ask your physicians if they participate in your health insurance plan’s Medicare Advantage network.

Things to Consider

• Medicare Advantage plans (such as PPO and HMO plans) generally include prescription drug coverage.
• Your annual costs may vary depending on the premiums, copayments, coinsurance and benefits of the plan you select.
• Medicare Advantage plans may have copayments or cost sharing amounts on Medicare covered services that differ from the cost sharing amounts in Original Medicare.
• Medicare Advantage plans may change their monthly premiums and benefits each year. This also occurs in Original Medicare, as Part B premiums, standard deductibles and cost sharing amounts generally change annually on January 1.

Initial Enrollment Period 

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B, you can select other coverage options like a Medicare Advantage plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.

How to Enroll

You must first enroll in Medicare Part A and Part B before joining a Medicare Advantage plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Advantage plan and getting enrolled.

Open Enrollment Period 

October 15 through December 7

The Medicare Open Enrollment Period provides an annual opportunity to review, and if necessary, change your Medicare coverage options. Coverage becomes effective on January 1. During Open Enrollment, some examples of changes that you can make include:

• Join a Medicare Advantage (Part C) plan.
• Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
• Change from one Medicare Advantage plan to another.
• Add or Change your Prescription Drug Coverage (Part D) plan if you are in Original Medicare.

As of January 2019, a Medicare Advantage Open Enrollment Period is available from January 1 – March 31 every year. If you are enrolled in a Medicare Advantage plan, you will have a one-time opportunity to make changes to your Medicare coverage, which includes switching to a different Medicare Advantage plan OR returning to Original Medicare with the option to sign up for a Prescription Drug Coverage plan. This open enrollment period previously ran until February 15, but was extended by Congress to run until March 31 for those already enrolled in Medicare Advantage.

Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.