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SHIIP Explains Medicare Advantage Plans

From the North Carolina Department of Insurance, SHIIP Division

The SHIIP Division of the Department of Insurance has received an increased number of calls from seniors across the state who have enrolled in a Medicare Advantage plan without fully understanding the impact of their decision. These plans are available in all 100 counties in the state; however, Medicare Advantage plans are not the best fit for some beneficiaries because not every plan is accepted everywhere, though that is how they are often presented by agents.

Medicare Advantage plans are federally approved plans that are offered to seniors and other Medicare beneficiaries by private companies. Often they offer additional coverage options that are not typically included in Original Medicare (i.e., vision, hearing, prescription drug coverage). These plans offer health care coverage and allow seniors to seek care from any Medicare-approved doctor and/or hospital that is willing to give them care, and that accepts the terms of the plan.

While they may be a good choice for some Medicare beneficiaries, they may not be the right choice for you. It is crucial that you call all of your health care providers (doctors, hospitals, therapists, etc.) to see if they accept the Medicare Advantage plan you are thinking about joining.

To enroll in a Medicare Advantage plan you must live in the county where it is offered, and while Medicare plans do allow you to receive services outside your service area, these services may come at a higher cost to you. Medicare Advantage plans can charge a monthly premium amount above the Medicare Part B premium, and they can charge deductible and coinsurance amounts that differ from those under the Original Medicare plan. These amounts are paid out of your pocket.

SHIIP has received numerous complaints from seniors saying they were misled about joining a Medicare Advantage plan. If you find that you have mistakenly enrolled in a Medicare Advantage plan, you may be able to dis-enroll from the plan. However, there may be limitations on when you can dis-enroll. You can contact SHIIP directly to help you navigate the dis-enrollment process, write the company and request to be dis-enrolled or call the Centers for Medicare and Medicaid Service at 1-800-633-4227 and dis-enroll by phone. Regardless of which option you choose, keep a record of the case number, when you called or wrote, whom you spoke to and what you found out.

For any questions about Medicare Advantage plans, call SHIIP at 1-855-408-1212. 


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