Medicare Part C

An Introduction to Medicare Advantage

Medicare Advantage Plans, also known as Medicare Part C, are offered by private health benefits companies that contract with the federal government.

If you choose a Medicare Advantage plan from us, we’ll manage your Medicare Part A and Part B benefits, which means you have one source for your health care coverage.

These plans may give you more benefits than Medicare alone, including:

Coverage for extra days in the hospital
Prescription drug coverage (available with some plans)
Vision, dental, and hearing benefits (available with some plans)

Depending on the plan you choose and where you live, you may have to pay a monthlypremium. To help save health care dollars, plans may use provider networks.

Available Medicare Advantage Plans for 2012

There’s a range of Medicare Advantage Plans available. The broader the plan’s coverage, the more you’ll pay in monthly premiums.

Plan details and availability vary by location and company. Monthly premiums may vary from company to company. Medicare Advantage Plans for 2012 often have networks, which help you coordinate and manage your overall care. Depending on your location, one or more of the following Medicare Advantage Plans may be available to you:

Medicare Preferred Provider Organization Plan:

You have the freedom to choose any doctor whether they’re in or out of our network this make getting coverage for 2012 and seeing doctors so much more simple. You can see any doctor or specialist that you choose. If they are not in your Preferred Provider Organization (PPO) network, your cost may increase, except in case of emergency.However, the provider must be willing to accept Medicare and the terms and conditions of payment of the plan. The great advantage of 2012 PPO plans from Anthem Blue Cross and Blue Shield is that you have the flexibility of seeking care either within the network at a modest cost to you or out-of-network at an additional cost. It’s your choice.

Medicare Health Maintenance Organizations Plan:

The plus of a Health Maintenance Organization (HMO) plan from Anthem Blue Cross and Blue Shield is that you'll be using doctors and hospitals within our network, so you'll find that the savings can be substantial. Many of our HMO plans require you to choose a primary care physician (PCP), who will help manage your care by coordinating other doctors treating you. Your PCP can be an internist, a family practitioner, or a general practitioner. With the exception of Medicare Advantage HMO plans offered in California, you don't need referrals to see a specialist, which is sometimes the case with other HMOs.

Medicare Private Fee-for-Service Plan:

On a Private Fee-for-Service Plan (PFFS), you may see any doctor or specialist without staying in a provider network. However, the provider must be willing to accept Medicare and the terms and conditions of payment. You do not need a referral to see a specialist. A PFFS plan is a great choice if you want predictable copayments** for most covered services and like to have freedom of choice wherever you are—at home or traveling.

**A copayment is an amount you may be required to pay as your share of the cost for a medical service, like a doctor’s visit or a prescription. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription.

Available Medicare Advantage Prescription Drug Plans:

Medicare Advantage Prescription Drug Plans (MA-PDs) — These plans are more like traditional health insurance, offering medical benefits (with the option of drug coverage) and services not available in Medicare Part A and Part B. Not all Medicare Advantage plans include prescription drug coverage, so be sure to choose an MA-PD plan if you need prescription drug coverage.

Why Choose Anthem Blue Cross and Blue Shield?

It’s not just premiums that vary—it’s service, too. We think you’ll find that we offer an unbeatable combination of top-notch service and premiums* that fit your budget.

You’re free to choose the coverage that’s right for you. Keeping monthly premiums* as low as possible is important to some people, while others want to save as much as possible on out-of-pocket costs.

Just as important, you get reliable, reputable service. You can rest assured that we’ll be here with the quality coverage you need, when you need it — today and tomorrow.

*Premium is a periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.

You’re free to choose the coverage that’s right for you. Keeping monthly premiums as low as possible is important to some people, while others want to save as much as possible on out-of-pocket costs.

Just as important, you get reliable, reputable service. You can rest assured that we’ll be here with the quality coverage you need, when you need it — today and tomorrow.

Get Reliable Help from Our Health Benefits Advisors

We're here to answer your questions seven days a week, from 8 a.m. to 8 p.m. Eastern time.

Phone: 216-539-5302

Know for sure you’re eligible for a Medicare Advantage or Medicare Advantage with Prescription Drug plan (MA-PD):

If you have Medicare Part A and Part B (or will have Medicare Part A and Part B as of the effective date) and you enroll during one of the enrollment periods, you’re eligible to join a Medicare Advantage plan.
To be eligible for our plan, you must also reside in our service area. Generally, you are not eligible if you have End-Stage Renal Disease.

Please keep this in mind: If you inadvertently sign up for Medicare Part D prescription drug coverage from any other plan, you will be automatically disenrolled from your Medicare Advantage plan. If you choose to, you can go back to Original Medicare and get a Medicare Supplement policy. But keep in mind that you can only join or leave a plan at certain times during the year.

When to Enroll in a Medicare Advantage or Medicare Advantage with Prescription Drug plan (MA-PD):

You can enroll in a MA or MA-PD plan
at different times throughout the year, and there are several different types of enrollment periods. You can sign up only during one of these three enrollment periods:

Initial Enrollment Period:

You first become eligible for Medicare the month of your 65th birthday or the month you qualify due to disability or end-stage renal disease. The best time to enroll in a PDP is during your Initial Enrollment Period (IEP), a seven-month period that starts three months before the month of your 65th birthday and ends three months after the month of your 65th birthday.

For example, if you turn 65 on May 20, 2011, you can enroll February 1, 2011, through August 31, 2011. In general, people who first become eligible for Medicare after January 1, 2011, will have the same IEP for Medicare Part D as they do for Medicare Part B.

Annual Coordinated Election Period

If you miss your Initial Enrollment Period (IEP), you’ll have to wait until the next Annual Election Period (AEP). This may result in a late enrollment penalty. If you enroll during the AEP, your coverage will start in January of the new year. If you’re already receiving Medicare, the AEP is your chance to switch coverage options.

Please keep in mind that when you shop for Medicare Prescription Drug and Medicare Advantage plans, the next Annual Enrollment Period (AEP). is October 15, 2011 through December 7, 2011. During AEP, Medicare beneficiaries may join or switch Medicare Prescription Drug or Medicare Advantage plans.

Special Enrollment Period:
In certain circumstances, you may sign up for a plan outside of the AEP. A Special Enrollment Period is sometimes available, such as when a person permanently moves outside the Medicare Advantage plan’s service area or a Medicare Advantage provider breaks its contract with an individual orplan does not renew its contract with the Centers for Medicare & Medicaid Services (CMS). There are other exceptional conditions that CMS determines. Beneficiaries who move into, reside in, or move out of a nursing home also may have an Special Enrollment Period. During this time, those eligible may enroll in or change Medicare Advantage Plans.

Please note that there is a Medicare Advantage Disenrollment Period (MADP) in 2012:

The next MADP is January 1, 2012, through February 14, 2012. If you choose to dis-enroll from a Medicare Advantage plan during the MADP and your plan includes a drug plan, you will be allowed to sign up for a stand-alone Part D plan to replace the drug coverage that was in your Medicare Advantage plan. This means that if you shop around for another Medicare Advantage plan, you will need to consider changing your plan during AEP (October 15, 2011 through December 7, 2011) because after January 1, 2012, you will not be able to change from your current Medicare Advantage plan to another Medicare Advantage plan unless you qualify for a Special Election Period.