If you’re new to Medicare and considering Medicare Advantage Plans, then you might be wondering what exactly is covered by Medicare Advantage Plans and what makes one option better than another.
Medicare (Original Medicare) has many parts - A for Hospital Insurance, B for Medical Insurance, and D for Prescription Drug Coverage. Medicare Advantage Plans are considered "Part C".
The benefit of choosing a Medicare Advantage Plan is that they offer bundled plans that combine parts A, B, and even D for maximum coverage and ease. These plans are typically offered by a private company that contracts with Medicare and they offer several options, depending on your needs.
The short answer to the question "What do Medicare Advantage Plans cover?" is this: Everything covered under Medicare is covered by Medicare Advantage Plans. Medicare Advantage Plans can only offer more coverage – not less!
The long answer to the question is detailed below...
Part A plans are critical to your healthcare needs and, thankfully, are required coverage on all Medicare and Medicare Advantage Plans.
Part A plans are considered "hospital insurance." In other words, this part of Medicare makes sure that you have inpatient hospital coverage – and it’s included in any Medicare Advantage Plan.
While there are some limitations included with Part A, you’re covered when it comes to the following needs:
This includes care received at acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care facilities.
The reason you might consider choosing a Medicare Advantage Plan rather than Medicare alone is that you might gain additional benefits along with your inpatient hospital coverage.
This coverage will vary based on your Medicare Advantage Plan, but only for the better. You will always receive the same coverage that Original Medicare offers for Part B, but you will see some variance in plans when it comes to additional Part B benefits.
The most helpful way to consider Part B coverage is to see it as two parts: One being necessary medical coverage and the other being preventative medical coverage.
Medically necessary coverage is anything (services or supplies) needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine – like stitches!
Preventative medical coverage is anything used to prevent illness (like a flu shot) or detect it at an early stage, when treatment is most likely to work best.
Medicare Part D coverage is an optional benefit to everyone who has Medicare. Part D coverage is coverage for prescription and even over the counter drugs – depending on your plan. Your medications and even certain vaccines will fall under Part D coverage.
Medicare Advantage Plans often offer Parts A, B, & D in a perfectly bundled package – which is one of the biggest benefits to choosing a Medicare Advantage plan.
As you consider your Medicare Advantage Plans, it’s important to study what is included in them. Not all are created equal and Part D coverage is a key differentiator!
Not only will you want to make sure your plan includes Part D coverage, but you’ll want to understand what is included within that coverage and whether it’s the best plan for you.
In addition to Original Medicare coverage and (oftentimes) Part D coverage, Medicare Advantage Plans often include additional benefits.
Most common benefits include dental, vision, and hearing care, but this list is expanding.
Wellness programs are a common addition to Medicare Advantage Plans. This would include gym memberships, weight loss programs, and more.
Other benefits can include transportation to doctor appointments, adult daycare, over the counter drugs, etc.
Whether you’re looking for a plan with a Part D Drug plan, dental insurance, vision care, etc., or not, Medicare Advantage Plans are a simple way to get more out of Medicare. You can only get more coverage when you choose a Medicare Advantage Plan.
Choosing the right Medicare Advantage plan depends on you! If it doesn't provide the coverage you need and expect (or the needs and expectations of your spouse/loved one) then it's not the plan you need.
One important option to consider is to simply get help. Because there's so much variance with Medical Advantage plans, it's often helpful to find a local advisor/agent who can explain exactly what a Medicare Advantage plan provides, how you will benefit from it, and what you can expect going forward. Plus, these agents will cost you nothing!
Plan Advisors Medicare agents are paid by carriers, are unbiased towards any one plan, and are really there to help you determine the best plan for you, personally, based on your needs and priorities.
They can even provide ongoing advice, no matter what you might encounter with your plan.
Common needs are:
So, what are you waiting for? Reach out to a Plan Advisor near you to get started!