Medicare Advantage:
Overview
Background on Medicare Advantage
On January 21, 2005, the Centers for Medicare & Medicaid Services (CMS) released the final regulations to implement two sections of the Medicare Modernization Act. The first is the Medicare Prescription Drug Benefit (CMS-4068- F). The second is the establishment of the Medicare Advantage Program (CMS-4069-F).
Other Statutory and Regulatory Citations for Medicare Advantage are also available.
Eligibility
A person can opt to receive Medicare through a Medicare Advantage (MA) plan as long as he or she meets the following requirements:
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Entitled to Medicare Part A,
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Enrolled in Medicare Part B,
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Resides in the area served by the MA plan, and
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Is not an individual qualified for Medicare benefits solely on the basis of end stage renal disease (ESRD) status.
Election and Enrollment
A Medicare beneficiary can elect to receive Medicare coverage through a Medicare Advantage plan by enrolling with an MA plan during an annual, initial, special, or open enrollment period. When individuals enroll, they agree to receive all of their health coverage from the plan facilities, providers, and contractors.
Disenrollment and Switching MA Plans
A person may switch MA plans during an enrollment period. By enrolling in a new plan, the beneficiary is automatically disenrolled from his/her old plan. Alternatively, a person may disenroll from an MA plan and return to original Medicare (Medicare Parts A and B) by disenrolling through the MA plan or through the Centers for Medicare and Medicaid Services (CMS).
See, 42 U.S.C. § 1395w-21; 42 C.F.R. § 422, et. seq.
HAP Resources
Chart: Annual Enrollment Periods
Chart: Special Enrollment Periods
