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About Medicare Advantage Plans

Select one of the links below to learn more about the differences between Medicare Advantage plans and other insurance, and find out if you or someone you know is qualified for coverage. There are additional options for people who are disabled, have a chronic disease, live in a nursing home, or need assistance with payment for medical services.

General Information

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How Are Medicare Advantage Plans Different than Original Medicare?

Medicare Advantage plans are great alternatives to selecting Original Medicare. You receive all the necessary services that Original Medicare offers plus more in most cases. The following information regards eligibility, providers, premiums and prescriptions.

  • You're still in the Medicare program.
  • You keep all your Medicare rights and protections.
  • You receive more benefits in addition to your basic Medicare coverage.
  • You must receive all routine care from plan providers.
  • If you obtain routine care from out-of-plan providers neither Medicare nor Southeast Community Care will be responsible for the costs.
  • Your primary care physician is responsible for the oversight of your care. Your primary care physician will coordinate the care you receive and is responsible for facilitating the referral process when you need to see specialists.
  • Members must use network pharmacies to access prescription drug benefits; if you find it necessary to use a pharmacy not in the network, you can ask us to reimbruse you for our share of the cost by submitting a paper claim form.
  • There are over 3000 medications covered on your plan. Please review the list of drugs to see if your drug is covered. All formularies are located on the Plan description page; to view plans in your area, select a link in the left-hand column.
  • Members may enroll in a Plan only during specific times of the year.
  • You cannot enroll in this plan if your current or former employer helps pay for your drugs.
  • Southeast Community Care's Medicare Prescription Drug Benefit is only available to members of the MA-PD Plan. If you are already enrolled in a MA-PD Plan, you must receive the Medicare Prescription Drug Benefit through that Plan.
  • Beneficiaries may be enrolled in only one Part D Plan at a time.
  • With Medicare Advantage Plans, you may pay a monthly premium and you must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
  • Medicare beneficiaries may also enroll through the Center for Medicare and Medicaid Services Online Enrollment Center, located at www.medicare.gov Link out.

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Medicare Parts A, B, C & D

Medicare Part A is for Hospital Insurance

Part A helps cover inpatient hospital care, skilled nursing care, home health care, and hospice care. There is no additional cost for Part A if you've worked in the United States 40 quarters (about 10 years) or more.

Medicare Part B is for Medical Insurance

Medicare Part B includes a monthly premium and helps cover services like outpatient, provider, and preventive care.

Medicare Part C is for Medicare Advantage Plans

These plans are approved by Medicare and provided by private insurance companies or health care organizations like us. In addition, many include prescription coverage, also known as Part D.

Medicare Part D is Medicare Prescription Drug Coverage

Medicare prescription drug coverage is available to all Medicare beneficiaries and is optional. Medicare Prescription Drug coverage is only available through private insurance carriers and helps pay for your prescription drug costs.

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When Can You Enroll in a Medicare Advantage Plan?

You may enroll three months before your 65th birthday, the month of your 65th birthday, or three months after your 65th birthday. It is important to understand the difference between the health plan benefits your employer offers and benefits offered through a Medicare Advantage plan. Be sure to talk to your company's benefits administrator before deciding which health plan is right for you.

If you're not 65 but you are disabled, you're eligible for Medicare after you've received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months. You can enroll during the three months before to three months after your 25th month of disability.

Enrollment periods vary if you did not recently become eligible for Medicare. You must be enrolled in both Part A and Part B and can apply for coverage three months before or three months after your Part B coverage starts.

November 15 - December 31

November 15 marks the beginning of the Annual Election Period (AEP). This enrollment period runs through Dec 31 and allows Medicare beneficiaries to enroll in or disenroll from a Medicare Advantage plan.

January 1 – March 31

The Open Enrollment Period (OEP), which runs January 1 through March 31, allows you to switch only once to a similar plan.

April 1 - November 14

April 1 through November 14 is known as the "lock-in" period. In most cases, you must stay enrolled in your current plan through December 31.

January 1 - December 31

Individuals are eligible for enrollment during this Special Election Period if:

  • You were enrolled in a plan and recently moved
  • You entered a nursing home
  • You are eligible for both Medicare and Medicaid
  • You qualify for low income subsidy
  • You are disenrolling from an employer group health plan
  • You involuntarily lost creditable prescription drug coverage

When is my coverage effective?

Generally, once your enrollment is complete, your coverage begins on the 1st day of the following month. If you enroll between November 15 and December 31, your coverage is effective January 1 of the following year.

To find out if you qualify under other special conditions, please Contact Us.

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Qualifying for Extra Help with Medicare costs

You may receive extra help with Medicare costs if you have Medicare and qualify for the following programs. Please contact us for more information or questions about eligibility.

Medicaid

This joint state and federal program helps people with limited income and resources pay for healthcare.

Programs of All-inclusive Care for the Elderly (PACE)

A combination of medical, social, and long-term care services available only in states that choose to offer it under Medicaid. Eligibility requirements vary from state to state.

Medicare Savings Programs

A program where your state Medicaid program helps you pay your Medicare premium and, in some cases, deductibles and coinsurance. These Medicare Savings programs have different names in each state.

Supplemental Security Income (SSI) benefits

A program for people who are disabled, blind, or over age 65 AND have limited financial resources. SSI is NOT the same as Social Security benefits.

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Programs to help with Pharmacy Costs

You may obtain help with pharmacy costs by using low cost, generic alternatives for brand name drugs, the Patience Assistance Program (PAP), $4 Generic Prescription Programs, or the Pharmaceutical Manufacturers Program. To learn more, please view the Help with Pharmacy Costs page.

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Does my situation qualify me for a Special needs Plan?

Medicare Special Needs Plans are designed uniquely for people with Medicare and Medicaid coverage or with chronic, severe, or disabling medical conditions. In addition, Special Needs Plans are available to those living in nursing homes and other types of institutions.

Who is Eligible for a Special Needs Plan?

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. The program helps people with chronic, severe, or disabling medical conditions, those living in nursing homes/ institutions, as well as people with limited income and resources pay for health care. For information about Medicaid, call your State Medical Assistance office. You can find the number on the Medicare Website or call 1-800-MEDICARE (1-800-633-4227, TTY users call 1-866-653-4261), 24 hours a day, 7 days a week.

What does Southeast Community Care offer for those who should be enrolled in a Special Needs Plan?

When you join Southeast Community Care, you are not trading in your valued Medicare and Medicaid coverage. You actually get more coverage through our coordinated care plan than with Original Medicare and still keep the same level of health care assistance that you receive from the state! Email us or Contact us for more information.

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I'm interested in a Medicare Advantage Plan — what's next?

For more information about qualifications and detail about enrolling in a plan, please see our How to Enroll page. You can also do the following:

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