✅ Medicare Part C (Medicare Advantage) Explained
Serving Seniors in Augusta, GA
Helping you compare your Medicare Advantage options with confidence
🧍 Tab 1: Who Qualifies for Medicare Advantage (Part C)
To enroll in a Medicare Advantage Plan, you must meet all the following:
✅ Be enrolled in both Medicare Part A and Part B
✅ Live in the plan's service area (many plans are county-specific – Augusta and surrounding areas qualify for various plan options)
✅ Not have End-Stage Renal Disease (ESRD) (although as of 2021, most people with ESRD can now enroll in MA plans)
✅ Be a U.S. citizen or legal resident
✅ Apply during a valid enrollment period
Medicare Advantage is offered by private insurance companies approved by Medicare. Plans often include extra benefits like vision, dental, hearing, and prescription drug coverage (MAPD).
💲 Tab 2: What the Cost Is for Medicare Advantage
Unlike Original Medicare, costs for Medicare Advantage plans can vary by plan and location. Here's what you can expect:
🔹 Premiums:
- Many plans have $0 monthly premiums
- You must still pay the Part B premium ($174.70/month in 2025, unless income-based IRMAA applies)
🔹 Out-of-Pocket Costs:
- Copays and coinsurance for doctor visits, hospital stays, etc.
- Out-of-pocket maximum: Once you hit this annual limit, the plan covers 100% of covered services
- Average in 2025: ~$8,850 (in-network), varies by plan
🔹 Extra Benefits:
- Some plans include:
- Vision, dental, hearing
- Gym memberships (like SilverSneakers)
- Over-the-counter (OTC) allowances
- Prescription drug coverage (Part D)
💡 Costs and coverage vary by plan — I can help you compare options available right here in Augusta.
📅 Tab 3: When Can One Sign Up for Medicare Advantage
Enrollment is limited to specific periods unless you qualify for a Special Enrollment Period (SEP).
🟢 Initial Enrollment Period (IEP)
- 7-month window around your 65th birthday
- Must have Part A and B before enrolling in a Medicare Advantage plan
🔄 Annual Enrollment Period (AEP)
- October 15 – December 7
- Switch, enroll in, or drop a Medicare Advantage plan
- Coverage begins January 1
🟡 Medicare Advantage Open Enrollment Period (MA-OEP)
- January 1 – March 31
- For people already in a Medicare Advantage plan
- You can:
- Switch to a different Medicare Advantage plan
- Drop it and go back to Original Medicare (and join a Part D plan)
🔵 Special Enrollment Periods (SEPs)
Available for specific situations, such as:
- Moving out of your plan’s service area
- Losing other coverage (employer, Medicaid, etc.)
- Plan changes or contract non-renewal
📅 I help clients in Augusta track these dates to avoid penalties and maximize benefits.
🔮 Tab 4: Possible Changes in 2026
Here’s what you might expect for Medicare Advantage in 2026:
📈 1. Premium and Benefit Adjustments
- Some plans may raise or lower premiums and out-of-pocket limits
- Additional benefits (OTC, dental, etc.) may expand or shift by carrier
🧾 2. CMS Oversight & Star Ratings
- The federal government may update how plans are scored
- Star ratings can impact plan quality, benefits, and marketing
💊 3. Integration of Drug Cost Reforms
- Drug cost caps and negotiated pricing under Medicare drug reform laws may affect MAPD plans (those with drug coverage)
📲 4. More Digital and Telehealth Services
- Continued focus on expanding telehealth, remote monitoring, and digital benefits
🛑 I’ll keep clients up to date on plan-specific changes as 2026 plans are released (usually by October 1).