Medicare Advantage Introduction:
“What do Medicare Advantage plans Cover” is one of the most important questions to ask when searching for plans. Health care needs are unique to every single person. About 10,000 Americans age into Medicare every single day so that means that there are 10,000 unique health care needs. A plan that works for someone else might not work for you. It’s important to understand exactly what Medicare is and what it covers.
What do Medicare Advantage plans cover? If you’re considering one of these plans as an alternative to Original Medicare, this article will help you decide if you’re getting adequate coverage.
First, what is Medicare Advantage?
Also known as Medicare Part C, Medicare Advantage is a more robust alternative to Original Medicare. These all-in-one plans cap the consumer’s annual health care spending and also offer more health benefits than Original Medicare.
Medicare Advantage Plan Coverage:
Medicare Advantage plans must cover all the services Original Medicare does—Medicare’s so-called alphabet of “parts,” which includes the following:
Hospital Insurance (Part A)
Medicare Part A covers inpatient hospital visits and hospital-related services, short-term nursing facility care, certain home health care visits, along with end-of-life hospice care.
Medical Insurance (Part B)
You will usually pay a monthly premium for the Medicare Advantage plan. For 2022, the standard Part B premium amount is $158.50 (or higher, depending on your income).
Prescription Drug Coverage (Part D)
The vast majority of seniors take prescription drugs. Because this part of Medicare is so important, if you do not enroll on a Part D plan when you become eligible for Medicare, you could face a monthly penalty fee. When speaking with a licensed insurance agent, be sure to ask: “What do Medicare Advantage plans cover” in order to ensure that you get the right plan for you. Almost all Medicare Advantage plans include Prescription Drug coverage so even if you don’t have any prescription right now, a Medicare Advantage plan will help protect you from any fees while also giving you the flexibility to add any drugs that you may need at a later date.
Medicare Advantage plans are also cost effective and some even provide $0 or low copays for a 90-day supply of Tier 1 and Tier 2 prescription drugs.
Non-Medically Necessary Coverage
This includes a wide range of health services not offered under Original Medicare. Medicare Advantage plans differ tremendously in the coverage they provide for these options, as we’ll see in the following discussions. If you’re not sure whether a service is covered, check with your provider before getting care.
If you have questions regarding what is covered under Medicare or what options you are eligible for, call a licensed insurance agent today to get the answers you need.
Health Extras Original Medicare Doesn’t Cover
Available healthcare coverage has changed quite a bit since 1965 when Medicare was enacted. One of the main reasons why people seek out alternatives to Original Medicare is that, despite its popularity, Original Medicare doesn’t cover a wide range of health services that today’s older Americans want and need.
Items like hearing, dental, and vision care are not covered by Original Medicare, but they are covered by Medicare Advantage. In fact, Medicare Advantage can even cover acupuncture and massage therapy depending on the plan you choose.
Vision, Hearing, and Dental Coverage
Most Medicare Advantage plans have some provisions for annual eye exams, and also offer allowances for eyeglasses and contact lenses.
Although significant hearing loss is common amongst older Americans, only a small percentage ever take advantage of hearing aids. Most Medicare Advantage plans cover hearing exams, and also offer allowances for the purchase of these devices.
Dental costs have been rising well above the annual rate of inflation for years. That makes the preventive and comprehensive dental coverage offered by most Medicare Advantage plans very appealing.
Learn more about getting hearing, vision and dental coverage.
Fitness and Wellness Resources
Many Medicare Advantage plans offer SilverSneakers®. This very popular program which helps encourage members to stay healthier through exercise by giving them access to fitness centers around the country.
While the Part B component of Original Medicare covers general preventive medical services, Medicare Advantage plans usually expand those services by including things like free health coaching, along with preventive health tools and other resources.
Because some older Americans have limited mobility, or have lost their driving privileges due to health concerns, it is very common for Medicare Advantage plans to offer transportation to and from primary care doctor appointments.
Like the high cost of prescription drugs, non-prescription medicines and various other health products can take a large portion of your budget, especially if you’re on a fixed income. An allowance for over-the-counter items like vitamins, cold medicine, aspirin, and bandages can be a welcome addition to your Medicare Advantage plan.
Worldwide Coverage for Urgent and Emergency Care
In most situations, Medicare won’t pay for healthcare or supplies you receive outside the U.S. Medicare Advantage plans—particularly the more robust Medicare Advantage PPO plans—fill that gap by providing worldwide coverage for urgent and emergency care.
In-Home and Adult Day Care Services
Since 2019, Medicare Advantage plans have been allowed to cover a range of in-home and adult day care services. But not all do. If you think you’ll be in need of these types of services, talk to a licensed insurance agent to find the appropriate plan for you.
Some Medicare Advantage plans even cover:
- Virtual doctor visits and a 24-hour nurse hotline
- Behavioral health tools and resources
- Allowances for personal emergency devices
Different types of Medicare Advantage Plans
Beyond the benefits previously discussed, the type of Medicare Advantage plan you have can also determine what is or is not covered and, just as important, what the plan benefits will cost you.
Medicare Advantage HMO Plans
Because they tend to be the most affordable type of Medicare Advantage plans, HMOs usually offer the most limited range of benefits. Nor do they provide coverage for out-of-network healthcare services, except in an emergency. Those that do offer out-of-network coverage usually cost more.
Medicare Advantage PPO Plans
Like their HMO counterparts, Medicare Advantage PPO plans offer a network of healthcare providers. But they also allow you to choose your own provider outside the network. Because of this flexibility, and the fact that they typically offer a broader range of benefits, they are significantly more expensive than an HMO plan offering the same benefits.
Medicare Advantage SNP Plans
Medicare Advantage SNP plans are for individuals who suffer from one of a number of severe or disabling chronic conditions, who reside in an institution (such as a nursing home), or who are eligible for both Medicare and Medicaid. As such, these plans provide specific benefits tailored to each of these types of beneficiaries.
A licensed insurance agent can help you decide which Medicare Advantage SNP plan might be appropriate for you, depending on the specific benefits it offers. There are a wide variety of plans available, and it can often be overwhelming at times. A licensed insurance agent can help guide you on your Medicare journey.
Find the Right Medicare Advantage Plan for You
Because it offers essential health care and peace of mind, Medicare Advantage plans have been a great benefit to aging Americans. But, just as every patient is a little different, Medicare Advantage plans can be different when it comes down to the details of what they offer.
You can also learn more by reading our blog How to Choose the Right Medicare Advantage Plan for You.