Introduction to Medicare Part C in Maryland (Medicare Advantage)

For those who are new to Medicare, you might not be aware that Medicare Parts A & B are not 100% comprehensive. Sure, they cover the majority of your healthcare needs, but there are certain services which are not covered that, if left unchecked, could cost you in the long run. There are many different types of Medicare supplement insurance designed to protect you and your life savings from these gaps. One such policy, called a Medicare Advantage Policy (or Medicare Part C), is designed to replace your federal Medicare benefits with a private health plan. This private plan provides seniors with basic Medicare benefits, additional coverage to protect you from Medicare gaps, and even offers you the option for ancillary benefits.

Federal Regulations for Medicare Advantage

When you sign up for Medicare Advantage, you are essentially transferring responsibility for your Medicare benefits from the federal government to a private insurance company. To protect consumers, federal laws prevent these private companies from offering you less coverage that what you are promised with Original Medicare (Medicare Parts A & B). Usually, though, Advantage plans come with benefits well beyond that of Original Medicare. And you, as a consumer, have the option to add more coverage if you can afford to.

Medicare Advantage Enrollment In Maryland

Medicare Advantage policies aren’t very popular in Maryland – only about 9% of Medicare recipients within the state are signed up for a Medicare Part C plan. This is below average for the rest of the country. Of those seniors who are currently enrolled in Medicare Advantage, the chart below displays the most popular plans:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

There are many factors which will help determine how affordable your coverage will be, as well as what sort of coverage you can hope to obtain. For obvious reasons, the healthier you are, the better. Additionally, seniors who enrolled in Medicare right when they turned 65 (Called the “Initial Enrollment Period”) will get more favorable rates than those who waited months or years. Below is a chart that shows estimates for plans near you:

Most Popular Medicare Advantage Plans in Maryland

Choosing a Medicare Advantage plan can be a complicated process. First, you have to find a provider you trust amongst the wide variety of companies available in your area. Next, you have to choose what type of Advantage plan you want – and there are many choices there, too. The biggest difference from one plan to another, however, is the provider network of doctors and hospitals where you will be allowed to get your medical care. Large networks are expensive, whereas smaller networks tend to come at a lower rate.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Depending on your plan, it is highly unlikely that your Medicare Advantage policy will be accepted as widely as Original Medicare. Advantage plans usually come with provider networks which, depending on the price of your policy, may come with a variety of choices – or be highly restrictive. Check with your current doctor to make sure that they are included in your Advantage policy’s provider network. Also, keep in mind that providers can change the rules and exclude doctors and facilities from their network at any time.

Doctor/Providers List

Drug, Vision and Dental Coverage

Most Medicare supplements, such as a Medigap policy, don’t leave room for extra coverage options which you may need. Some of these options include prescription drugs, dental care, and vision. But with a Medicare Advantage policy, you are free to combine all of these services together, or pick and choose which ones you would like to add. Advantage plans which include Medicare Part D prescription drug coverage are also known as MAPD plans.

Enrollment Options & Best Time To Enroll

The best time to enroll in a Medicare Advantage plan is when you are newly enrolled in Medicare, 65 years of age, and in good health. There will be fewer obstacles for you to overcome in order to get approved for coverage. Remember though that because you are applying to a private company, they are more likely to ask questions about your health and deny you over pre-existing conditions, such as ESRD (End Stage Renal Disease). However, you have options. Your state department of insurance will tell you more. You may also visit our Medicare Advantage Enrollment Page for more info.

  • Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.

What Medicare Advantage Plan Is Best For Me?

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