If you are eligible for Medicare, you may be considering enrolling in a Medicare Advantage Plan.
Before choosing a Medicare Advantage Plan, you may want to compare several plans by asking the insurance company or a licensed insurance agent these questions:
- What's my share of the costs for services and supplies?
- Does the plan have a network of providers for some or all types of services? (You may still be able to see providers who aren't part of the plan's network if they accept the plan's payment terms. But, you may pay more.)
- Does the plan offer benefits Original Medicare doesn't cover, like vision, hearing, dental, or prescription drug coverage? (You may have to pay more for these extra benefits.)
If you decide to enroll in a Medicare Advantage plan, you should consider enrolling in a plan that enables you to continue getting care from your preferred Atrium Health doctors and hospitals.
When you choose a health insurance plan with Atrium Health you get:
- Unmatched, world-class care from the region’s only nationally ranked health system which includes Levine Cancer Institute, Sanger Heart & Vascular Institute, Musculoskeletal Institute and more.
- Access to one of the largest primary care networks in the region, on-demand care including urgent care and online video visits, and the region's only Level I trauma center.
- Peace of mind that you can keep your out-of-pocket costs down when you get care from us.
Read on to learn more about this option for your health insurance coverage.
What is Medicare Advantage?
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans are offered by private companies and in many cases, you’ll need to use healthcare providers who participate in the plan’s network and service area in order to have the lowest costs.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
How do Medicare Advantage Plans work?
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans can also choose to cover even more benefits.
For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:
- Whether you need a referral to see a specialist
- Whether you have to go to doctors, facilities, or suppliers that are “in network” with the plan for non-emergency or non-urgent care
These rules can change each year.
What are the costs for Medicare Advantage Plans?
What you pay in a Medicare Advantage Plan depends on several factors, including the scope of benefits that are covered by the plan. In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area. For detailed information, visit www.medicare.gov.
When is Open Enrollment?
Medicare Open Enrollment, also known as the Annual Enrollment Period (AEP) will take place from October 15 – December 7, 2021. If you are over 65 (or turning 65 in the next three months), this is the time of year to review your health insurance coverage options.
During this enrollment period, newly eligible and existing Medicare patients can review Medicare coverage options and can choose to:
- Switch from Original Medicare (Medicare Parts A and B) to Medicare Advantage, or vice versa
- Change from one Medicare Advantage plan to another
- Add or change Medicare prescription drug plans
- Make no changes to current Medicare coverage
Which plan should I pick?
If you decide to enroll in a Medicare Advantage plan, you should consider enrolling in a plan that enables you to continue getting care from your preferred Atrium Health doctors and hospitals.
Atrium Health is an “In-Network” provider for Medicare Advantage Plans offered by:
- Aetna Medicare from Aetna CVS Health (NC, SC)
- ApexHealth (This is a new plan being offered for the first time during the 2021 open enrollment)
- Blue Medicare from Blue Cross Blue Shield of NC
- Blue Cross Blue Shield of SC members may have access through the Blue Card program
- Cigna Healthcare (formerly Cigna HealthSpring)
- Humana Medicare Advantage (NC, SC)
- United Healthcare Medicare Advantage (including AARP plans)
- WellCare (NC, SC) (This is a new plan being offered for the first time during the 2021 open enrollment)
Not all plans are offered in each county. Be sure to check with the plan when enrolling to confirm whether your preferred Atrium Health doctors, clinics, and hospitals are included in your plan’s network.
Do I have to renew my plan?
If you’re happy with your existing Medicare coverage, there’s no need to do anything during the annual enrollment period. But it’s always good to check that your current plan is still available, that your plan’s benefits still align with your current health needs, and that you can continue to see your preferred doctors and hospitals.
What should I do if I need to see a doctor before my new Medicare Advantage coverage begins?
Your new coverage begins January 1, 2022. As long as you remain covered under your current health plan, you can continue to see your physician(s) under that plan until your new Medicare Advantage coverage begins.
As always, if you have a medical emergency, go to the closest hospital emergency room. Atrium Health hospitals provide services to all patients seeking treatment for an emergency medical condition, regardless of their health insurance plan or ability to pay for emergency services.
Where can I get more help in selecting a Medicare Advantage plan?
You can contact the Senior Health Insurance Information Program (SHIIP). They list Medicare Advantage plans by county that are available for 2022. Call them at 855-408-1212 or visit their website. You may also contact your health insurance agent.
What if I sign up for a plan that doesn’t include my preferred Atrium Health doctors or hospitals?
If you sign up for a Medicare Advantage plan during Medicare Open Enrollment and your needs later change, you may have to wait until next fall to switch plans.
However, if you signed up for Medicare Advantage during Medicare Open Enrollment, you can elect to switch health plans (either Medicare Advantage or Original Medicare) between January 1, 2022 through March 31, 2022.
