What Medicare Advantage Plans & drug plans cover

  • Medicare Advantage Plans must cover all of the services that Original Medicare covers, and may offer some extra benefits — like vision, hearing, and dental services.
  • All plans with drug coverage must cover a wide range of prescription drugs that people with Medicare take, like drugs to treat diabetes.
  • Check with your plan to get specific information on what it covers.
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Joining a plan

To join a Medicare health plan or drug plan, you generally must:

  • Have Medicare 
    Part A (Hospital Insurance)
     and 
    Part B (Medical Insurance)
    .
  • Live in the service area of the plan you want to join.
  • Be a U.S. citizen or lawfully present in the U.S.
  • Have your Medicare Number and your Part A and/or Part B coverage start dates. 

When to join a Medicare health or drug plan

You can only join, switch, or drop a Medicare Advantage Plan (Part C) , other Medicare health plan, or Medicare drug plan (Part D)  at certain times, called enrollment periods. 

Enrollment period: You can: Coverage starts:

Initial Enrollment Period
(new to Medicare)

Starts 3 months before you get Medicare (Part A and/or Part B) and ends 3 months after you get Medicare.

Join any plan.

Varies, depending on when the plan gets your request:

  • If you request to join a plan before your Medicare Part A and/or Part B starts: Your plan coverage starts the same day as when your Medicare Part A and/or Part B starts.
  • If you request to join a plan after your Medicare Part A and/or Part B starts: Your plan coverage starts the first of the month after the plan gets your request.

Initial Enrollment Period – New to Part B
(only applies if your Part A coverage has already started and you add Part B)

Starts 3 months before the month you’re first eligible for both Part A and Part B. You’ll have 2 months after you get both Part A and Part B for the first time to join a plan.

 Join any Medicare Advantage Plan with or without drug coverage. The month after you join the plan.
Open Enrollment Period
October 15-December 7.
  • Join, drop, or switch to another Medicare Advantage Plan with or without drug coverage (or add or drop drug coverage).
  • Switch from 
    Original Medicare
     to a Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare.
  • Join, drop, or switch to another Medicare drug plan if you’re in Original Medicare.
 January 1 of the next year (the plan must get your enrollment request by December 7).

Medicare Advantage Open Enrollment Period
(only if you’re already in a Medicare Advantage Plan)
  • Switch to another Medicare Advantage Plan with or without drug coverage.
  • Drop your Medicare Advantage Plan and return to Original Medicare.  You'll also be able to join a separate Medicare drug plan.
 First of the month after the plan gets your request.
Special Enrollment Period
Varies. Only for certain situations that happen in your life, like moving to a new address, losing or changing your current coverage, getting Medicaid, or getting Extra Help to pay drug costs. 

Depending on your situation:

  • Join a Medicare Advantage Plan (with or without drug coverage) or Medicare drug plan
  • Switch to another plan

If you sign up for Part A and/or Part B during a Special Enrollment Period because of an exceptional situation, you’ll have 2 months to join a plan or switch to another plan.

 Varies. Generally, the first of the month after the plan gets your request.

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

How to join a Medicare health or drug plan

1. Find out which plans are available in your area.

  • Compare plans in your area – Find out what they cost and services they provide. Enter prescription drugs you take to get an estimate of your monthly and yearly cost for each plan.
  • Use your “Medicare & You” handbook to find plans – they’re listed in the back.
  • Talk to a trusted agent / broker 

2. Make sure the plan meets your needs:

  • Check if the plan covers your prescriptions and includes the benefits you need.
  • Ask your doctors and pharmacies if they’re in the plan’s network.
  • Review costs, like monthly premiums, 
    deductibles
    , and the estimate of your yearly costs for drugs you take.
  • If you have other health insurance or drug coverage, talk to your benefits administrator or other insurance provider before you make any changes to your current coverage.
  • If you live in another state for part of the year, check if the plan will cover you there.

3. Join the plan. Once you choose a plan, you can:

  • Select “Compare & Enroll” for the plan you want to join.
  • Contact the plan to join. You can call them or visit their website. You can also ask for a paper form to fill out and mail back to the plan, but they must get it before your enrollment period ends.
  • Give a Call 

How would you like to proceed?

What Medicare Advantage Plans & drug plans cover

  • Medicare Advantage Plans must cover all of the services that Original Medicare covers, and may offer some extra benefits — like vision, hearing, and dental services.
  • All plans with drug coverage must cover a wide range of prescription drugs that people with Medicare take, like drugs to treat diabetes.
  • Check with your plan to get specific information on what it covers.

ENROLLMENT PERIODS 

IEP – Initial Enrollment Period (Three months before or three months after becoming eligible for Medicare)

ICEP – Initial Coverage Enrollment Period MA (Three months before or three months after becoming eligible for Medicare) Delayed Part B for MA or MAPD (Three months prior to their Part B effective date)

OEP-N - Open Enrollment Period (For new MA enrollees following IEP/ICEP initial enrollment, 90 days from A/B effective date)

SEP – Special Enrollment Period (Can be used throughout the year, depending on one's situation)

DST - Weather emergency or disaster

LEC - Lost employer coverage

MOV - Moved to a new service area

5ST - Changing to 5-Star plan

NLS - Gain, Lose or a Change in LIS-Eligible Status

ACC - Carrier or CMS were unable to provide required notices or information in an accessible format

CSP - Enrolled in Medicare premium-Part A or Part B using an Exceptional Condition (Do not use for PDP)

DIF - Auto assigned by CMS or State

DSP - Enrolled in Medicare premium-Part A or Part B using an Exceptional Condition (MAPD, PDP)

ICE - Delayed Part B

INC - Released from incarceration

LAW - Non-U.S. citizens who become lawfully present in the United States

LCC - Lost creditable coverage

LPI - I’m in a plan that’s had a star rating of less than 3 stars for the last 3 years. I want to join a plan with a star rating of 3 stars or higher

LT2 - I live in a long-term care facility, like a nursing home or a rehabilitation hospital.

LTC - Moved out of an institution

MCD - Change in Medicaid Status

MYT - Current plan is not renewing

PAC - Enrolling in Program of All-inclusive Care for the Elderly (PACE).

PAP - State Pharmaceutical Assistance Programs (SPAP) member

PRE - Enrolled in Part B during the Part B General Enrollment Period when NOT entitled to free Part A

REC - I’m in a plan that was recently taken over by the state because of financial issues.

RET - I’m new to Medicare, and I was notified about getting Medicare after my Part A and/or Part B coverage started.

RUS - Moved back to the U.S. after living abroad

SNP - Loss of Special Needs Status

OTH - Other