Medicare Advantage Plans

Frequently Asked Questions

What is the Affordable Care Act?

The Affordable Care Act is the health insurance reform legislation that was passed by Congress and signed into law by President Obama on March 23, 2010. For more information about The Affordable Care Act, visit (link opens in new window) , you can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also contact your State Health Insurance Assistance Program (SHIP). In Florida, the State Health Insurance Assistance Program is called Serving Health Insurance Needs of Elders (SHINE) (link opens in new window) . The toll free number is 1-800-963-5337; TTY users should call 711, Monday through Friday, 8 a.m. to 5 p.m. You can also write to: 4040 Esplanade Way, Suite 270, Tallahassee, FL 32399-7000.

What is Original Medicare?

Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people less than 65 years of age and people of any age with End-Stage Renal Disease

How does Medicare work?

It is important to understand there are four parts to Medicare:

  • Medicare Part A is hospital insurance – that helps pay for hospital stays, rehabilitative nursing facilities, home healthcare, and hospice. Most people don't have to pay a premium for Part A because it was prepaid through their payroll tax while they were working.

  • Medicare Part B is medical insurance – that helps pay for doctors' services and outpatient care. There is a monthly premium for Part B paid for by the member. If you don't sign up for Part B when you first become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but didn't enroll.

  • Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private insurance company like CarePlus. A Medicare Advantage plan provides Part A and Part B coverage and also, generally, provides additional benefits.

  • Medicare Part D is prescription drug coverage. In one way, Part D is like Part B: If you don't join at age 65, you may have to pay a penalty when you do join.

You are generally automatically enrolled in Medicare hospital insurance (Part A) without a premium when you apply for Social Security benefits – usually upon reaching 65 years of age or after receiving disability payments for 2 years and if you have 10 years of creditable employment. Part A helps cover inpatient care in a hospital or a limited stay in a skilled nursing facility.

Part B of Medicare helps cover physician and outpatient hospital services. You are responsible for paying the Part B premium which is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but it doesn't cover all of your healthcare costs. For example, you pay a deductible for each hospital stay and may typically pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.

What is Medicare Advantage?

Medicare Advantage is a type of health plan that is a way of getting your Original Medicare benefits from a private insurance company and was created by the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003. Some examples of Medicare Advantage plans are:

  • Health Maintenance Organization plans (HMO)
  • Preferred Provider Organization plans (PPO)
  • Private Fee-for-Service plans (PFFS)

What is a Medicare Advantage HMO?

An HMO features specific lists of in-network doctors, hospitals, and other providers that you must use to receive benefits. Medicare Advantage HMOs often provide additional benefits not found in Original Medicare, including reduced cost-sharing, prescription drug coverage and wellness or fitness programs. If you select a Medicare Advantage HMO, you use it instead of your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

What is the Medicare Part D drug benefit?

As of January 1, 2006, anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in a prescription drug benefit plan, Medicare Part D. This benefit was designed to help Medicare consumers handle the rising cost of drugs and give them easier access to prescription medications.

What is a Prescription Drug Plan (PDP)?

A PDP is a private stand-alone prescription drug plan (PDP) that offers coverage for prescription medications, Part D. This plan can be used with Original Medicare or a Medigap plan.

An individual cannot be enrolled in more than one PDP at the same time. For this same reason, an individual may not be enrolled in a PDP and a Medicare Advantage (MA) plan that also includes prescription drug coverage at the same time. Exceptions include MA Private Fee-For-Service (PFFS) plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.

If you are considering a PDP, please keep the following in mind:

  • Optional plan. A PDP is an option – not a requirement. However, if you don't join a PDP or a Medicare Advantage plan with prescription drug coverage, or have a prescription drug plan (PDP) as good as Medicare’s, you won’t have coverage for your prescription drugs and will have to pay a higher premium if you join later.
  • Monthly premium. PDPs have a monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans offer medical and prescription drug coverage together for one monthly premium. CarePlus does not offer a stand-alone prescription plan. You must continue to pay your Medicare Part B premium. The Part B premium may be covered through your State Medicaid Program.
  • How does it work with a Medicare Advantage plan? If you are enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that is the case, choosing a PDP is not necessary – in fact, getting a PDP would disenroll you from your Medicare Advantage coverage. All CarePlus plans are Medicare Advantage plans and include prescription drug coverage.

What is the difference between a preferred cost-share and standard cost-share pharmacy?

Preferred cost-share pharmacies provide prescriptions for our Medicare members at a lower cost-share (e.g., copayments) than standard cost-share pharmacies.

Standard cost-share pharmacies provide prescriptions for Medicare members at a higher cost-share (e.g., copayments) than preferred cost-share pharmacies.

What questions should I consider when choosing a Medicare health plan?

Before you select a plan, carefully consider the following questions:

  • Do you already have a doctor you like?
  • Are you choosing a new doctor?
  • Is freedom to go to any doctor and any hospital very important to you?
  • What are your current or previous health conditions?
  • Do you need a prescription drug plan (PDP)?
  • What prescription drugs are you currently taking?
  • Are the drugs you take covered by the plan's formulary (drug list)?

When can I actually enroll into a Medicare Advantage plan?

Here's a quick review of the key dates for enrollment periods and other deadlines:

  • October 1 to October 14, 2018: 2019 benefit and premium information is available from all organizations, so you can shop, compare and be ready to enroll by October 15, 2018.
  • October 15 to December 7, 2018 - Medicare Advantage and Prescription Drug Plan Annual Election Period, AEP: Medicare beneficiaries can enroll in a 2019 Medicare health benefits plan, such as a Medicare Advantage HMO plan, or a stand-alone prescription drug plan (PDP).
  • January 1 to March 31st, 2019 – Medicare Advantage Open Enrollment Period: Medicare beneficiaries enrolled in a Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan can switch to another MA or MAPD plan or disenroll from a MA or MAPD plan and return to Original Medicare (and add a Part D, if desired). The new plan’s effective date for a beneficiary that changes to a different MA plan is the 1st day of the month following the month of enrollment. (This enrollment period does not allow for Part D changes for beneficiaries enrolled in Original Medicare.)

Where can I get more information about Medicare Advantage and Prescription Drug Plans, Medical Assistance and my Social Security benefits?

For more information about Medicare Advantage or prescription drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:

Centers for Medicare & Medicaid Services (CMS)

Website: (link opens in new window) 


TTY 1-877-486-2048

24 hours a day, 7 days a week

For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).

Florida Medicaid (Agency for Health Care Administration)

Website: (link opens in new window) 

1-888-419-3456; Press Option 2 for general information about Medicaid

TDD 1-800-955-8771

Address: 2727 Mahan Drive, Tallahassee, FL 32308

Monday through Friday, 8 a.m. to 5 p.m.

Serving Health Insurance Needs of Elders (SHINE)

Website: (link opens in new window) 


TTY 1-800-955-8771

Fax: 1-850-414-2150

Address: 4040 Esplanade Way, Suite 270

Tallahassee, FL 32399-7000

Monday through Friday, 8 a.m. to 5 p.m.


For more information about Social Security or Railroad Retirement earnings, call or go online:

Social Security Administration (SSA)

Website: (link opens in new window) 

1-800-772-1213 (Generally, you’ll have a shorter wait time if you call during the week after Tuesday.) (link opens in new window) 

TTY 1-800-325-0778

Monday through Friday, 7 a.m. to 7 p.m.

U.S. Railroad Retirement Board

Website: (link opens in new window)


TTY 1-312-751-4701

24 hours a day, 7 days a week

Address: 844 North Rush Street

Chicago IL, 60611-1275

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