Medicare Benefit Plans: What They Cover
Medicare Advantage Part C combines Medicare Part A and Part B coverage with additional benefits such as dentistry, vision, hearing and others.
- Medicare Advantage is sold by private insurance companies.
- When purchasing a Medicare Advantage plan, your costs will depend on where you live and the plan you choose.
If you are in the market for a Medicare plan, you may be wondering which Medicare Advantage Part C plans are covered.
With a Medicare Advantage plan, everything under Original Medicare is included, such as: B. Hospital and health insurance. However, most Medicare Advantage plans also cover additional health-related services, such as: prescription drugs , vision and dental .
In this article, we’ll examine what Medicare Advantage is, what it covers, what it costs, and when you might consider a Medicare Advantage plan.
What is Medicare Advantage?
Medicare is a type of government-funded health insurance available to people over the age of 65 in the United States.
There are different types of Medicare plans to choose from depending on the coverage you are looking for. Original Medicare Coverages :
- Medicare Part A. Part A includes hospital services, nursing facilities, home care, and hospice care.
- Medicare Part B. Part B includes preventive healthcare and medically necessary services for health conditions.
Medicare Advantage plans, also known as Medicare Part C or MA plans, are insurance plans that offer Medicare with additional coverage. Medicare Advantage is offered by private insurance companies that contract with Medicare.
You qualify for Medicare Advantage if you already have Medicare Parts A and B.
There are different types of Medicare Advantage plans to choose from based on your needs. This includes :
- Health Maintenance Organization HMO. HMO Plans Specify that you can only receive services from doctors and facilities that are in the network. Specialists need referrals outside the network.
- Preferred Provider Organization PPO. PPO Plans Doctors, providers, and hospitals all have different fees depending on whether they are on the network. You pay more for services outside the network.
- Private Service Fee PFFS. PFFS Plans You can get services from any provider as long as they accept the payment terms of your PFFS plan.
- Special Needs Plans SNP. SNPs are offered to specific groups of people who need long-term medical care for chronic conditions.
- Medicare Medical Savings Account MSA. MSA Plans Combine a high-deductible health insurance plan with a medical savings account where Medicare puts money to be used for medical services.
What does Medicare Advantage cover?
Medicare Advantage plans provide both health and medical insurance coverage and supplemental coverage. Depending on the type of insurance plan you choose, you may be covered for:
- Health Insurance Part A. This includes inpatient hospital visits and hospital-related services, short-term care in nursing homes, medically necessary home health visits and hospice care at the end of life.
- Health Insurance Part B. This includes preventive, diagnostic and treatment-related services for medical conditions. Many Medicare Advantage plans also cover ambulance transport.
- Prescription Medicines. This is not typically offered under Original Medicare. Almost all Medicare Advantage plans offer coverage for prescription drugs.
- Dentistry, Vision and Hearing. This includes non-medically necessary coverage not offered under Original Medicare. Most Medicare Advantage plans vary in the coverage of these options.
In addition, some companies offer other health-related ones. Benefits under their Medicare Advantage plans, e.g. B. Gym membership, ambulance and meal delivery.
HELP SOMEONE CHOOSE A PLAN?
When helping a family member or friend choose a Medicare Advantage plan, you should consider the following:
- What type of coverage do you need? Are you just looking for prescription drugs, or are you also interested in dental or vision insurance? Are you interested in other health-related services?
- What kind of expenses can they afford? Consider whether an MA plan will cover premiums or deductibles, what monthly and annual costs the plan will incur itself, and how often and to what extent medical care will be required.
- What type of Medicare Advantage plan are they interested in? Does an HMO plan best suit their needs, or are they better off with a PPO or MSA plan? Do they have specific long-term costs that only an SNP plan can cover?
- What other factors might impact their medical needs? Do you travel or do you need out-of-state care under certain conditions? Are they predisposed to certain conditions that require future referrals or off-network visits?
How much does it cost?
With Original Medicare, Medicare Part B requires you to pay a monthly out-of-pocket premium. This premium is adjusted each year and calculated based on your 2019 income tax filing.
Medicare Part B also has an out-of-pocket annual deductible. After you meet this deductible, you must pay 20 percent of all Medicare-approved services.
If you sign up for a Medicare Advantage plan, your cost might be slightly different. Many plans cover a portion of your monthly Medicare Part B premium.
A Medicare Advantage plan may also have its own monthly premium and annual deductible in addition to your Medicare Part B costs.
One benefit of a Medicare Advantage plan is that most other expenses have an annual cap, which can help lower your overall costs.
The total cost of a Medicare benefit plan is generally determined by premiums, deductibles, and so on. Co-payments , how often and where you seek services, what types of services you need, and whether you receive them Medicaid .
Given all of these factors, there are no specific costs associated with a Medicare Advantage plan. These are all important things to consider when comparing plans.
Pros and cons of Medicare benefit plans
While a Medicare Advantage plan might seem like an easy choice for Medicare coverage, consider the following: Pros and cons :
Benefits of MA Plans
- Many MA plans offer additional coverage that Original Medicare doesn’t offer, such as prescription drugs, dentistry, vision, hearing, and more.
- MA plans provide in-network care that is easier to coordinate.
- research has shown that MA plans can result in lower prices for medical services compared to Original Medicare.
Disadvantages of MA plans
- Depending on which plan you choose, your provider options may be limited.
- If you need to see a specialist under certain conditions, you may first need a referral.
- If you travel, your out-of-town services may not be covered.
Additional considerations when choosing a Medicare Advantage plan
You can benefit from a Medicare Advantage plan if you want full Medicare coverage and more. If you’re interested in prescription drug insurance and annual dental and vision appointments, a Medicare Advantage plan is a good option.
If you have chronic medical conditions, an SNP can help cover some long-term medical costs. You can also benefit from an MSA plan if you need funds for a variety of medical services year-round.
However, if you find that you don’t need additional coverage for things like dental, vision, hearing, or prescription medication, a Medicare Advantage plan may not be right for you.
The same applies if you want the freedom to choose your own providers. If you need out-of-town coverage, a Medicare Advantage plan may not help cover those unexpected medical expenses.