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If a client asks what a Medicare Advantage Plan covers, keep reading and get some answers. Medicare Advantage plans, also known as Medicare Part C, provide a comprehensive alternative to Original Medicare. Private insurance companies that are approved by Medicare offer the plans. The plans must cover all services covered by Medicare Part A (hospital insurance) and Part B (medical insurance). Although, Medicare Advantage plans usually provide more than just the basic coverage. Most plans provide additional benefits that make them more attractive to many beneficiaries.

Core benefits

Hospital coverage:

Just like Medicare Part A, Medicare Advantage plans cover inpatient hospital stays, skilled nursing facility care, and hospice care.

Medical Services:

Advantage plans cover the same standard Part B services as Original Medicare. This includes coverage of doctor visits, outpatient medical care, preventive services, and medical equipment.

Additional benefits

Many Medicare Advantage plans include services that Original Medicare doesn’t cover. The items below are not included in all plans as each plan varies by provider, state and exact location.

Prescription Drug Coverage:

Medicare Advantage plans labeled MAPD include prescription drug coverage (Part D) many prescription medications. If the Advantage plan is labeled MA only, it does not include prescription drug coverage.

Vision Services:

Some plans cover routine eye exams as well as some coverage for glasses and contact lenses.

Hearing Services:

Hearing coverage in some plans include hearing exams and a portion of the cost for hearing aids.

Dental Care:

Dental coverage is one of the most popular benefits that is often included in Medicare Advantage Plans. Many plans cover routine dental exams, cleanings, and sometimes restorative dental procedures.

Wellness Programs:

Many plans offer a reimbursement or a free fitness membership as well as other incentives to encourage members to practice healthy living habits.

Other Advantage Plan benefits:

Some plans provide things like; transportation services to and from medical appointments. While others provide OTC benefit cards that members can use for over the counter products, healthy foods or even to help pay utility bills or numerous other items. It is important to remember, each plan offers different benefits.

Plan costs

At present, many Medicare Advantage plans offer low to no cost plan options. Plan enrollees are required to pay a monthly Part B premium in addition to any plan premium they might have. Other costs include deductibles, copays, and coinsurance. The amount of these costs vary depending on the specific plan. Although some plans offer $0 premiums, it’s important to review all out-of-pocket costs.

Plan networks

Medicare Advantage plans use a specific network of providers. In general, there are a few different types of plans, The two main plans are either part of an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Whatever plan a beneficiary considers, they must be sure their doctors and hospitals are part of the plan’s network to avoid paying higher costs.

Limitations and Considerations

Although Medicare Advantage plans may include some great added benefits, beneficiaries need to consider their limitations. Their limitations include the network restriction; if the member needs to use care outside the network, they may pay added fees or even the entire cost of some care.

HMO plans require enrollees to have specialist visits approved by their primary provider before they seek care. This can add to the time it takes to receive treatment. Enrollees may also have trouble seeking care outside their plan’s immediate service area.

If a beneficiary suffers from a serious illness such as cancer; they may have to pay a percentage of the cost of their treatment until they reach their maximum out of pocket.

Choosing the Right Plan

Selecting a Medicare Advantage plan requires careful consideration of the beneficiary’s healthcare needs, budget, and preferred providers. It is essential to understand what is important to each individual and compare plans that provide the closest match to the client’s needs and wants. Licensed insurance agents can be an integral part of finding the best fit for the beneficiary.

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Medicare Advantage plans are great option for those looking for coverage at a low cost that offers additional benefits. However, it’s essential to understand the details of each plan to ensure it aligns with the healthcare needs and financial situation of each person.

Medicare dental benefits

Most people have heard about the additional benefits offered on some Medicare plans.  One of the most asked about benefits are Medicare dental benefits.  Although dental care is an integral part of overall health, in the vast landscape of healthcare, dental benefits are often overlooked.

The state of Dental coverage in Medicare:

Medicare plays a crucial role in ensuring individuals over the age of 65 and qualifying individuals with disabilities.  Unfortunately, the comprehensive healthcare coverage Medicare provides is definitely lacking when it comes to dental coverage.

As we have already mentioned, Medicare provides a great deal of coverage for various health services, yet dental care has traditionally held a separate status.  Neither Part A nor Part B (Original Medicare) cover routine dental care.  This includes things like check-ups, cleanings, fillings, and extractions.  These services can be quite expensive and many people on fixed incomes simply do not have the resources to afford the costly dental care they require.  This lack of coverage frequently leaves beneficiaries looking for supplemental options that will cover their oral health needs.

Medicare Advantage Plans with dental benefits:

These days, many people look to Medicare Advantage plans (Part C) to provide some relief from the high cost of dental work.  Medicare Advantage plans are offered by private insurers and often provide additional benefits beyond Original Medicare. Many Medicare Advantage plans include dental coverage.  This coverage usually includes preventive and a few additional services.  In some rare instances, more extensive treatments like root canals or dentures are also covered to some extent.

Learn about some of the plan comparison tools that help clients sort out their options

Stand-alone Dental Coverage:

Many Medicare beneficiaries ask about dental coverage because they understand the importance of dental health.  This is where you need to explain that supplementary (stand-alone) plans cater specifically to dental care needs.  There are many different options available and many dental insurance carriers. Each carrier provides a few different coverage options that include things like checkups, cleanings, fillings and various other dental procedures. It is imperative that beneficiaries understand dental plans only work well if they use an in-network provider for dental care. As an agent, you need to check that their dentist is in network with any plan they are considering.

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The Importance of Routine Dental Care:

While navigating Medicare and dental benefits, it’s imperative to understand how important routine dental care is. Oral health can significantly impact overall well-being.  There are several studies that link poor oral health to various systemic conditions. Maintaining regular dental visits preserves a healthy smile and also contributes to overall health and quality of life.

Advocating for Future Changes:

Because of the critical role oral health plays in overall well-being, there’s an ongoing call for expanding Medicare to include comprehensive dental coverage.  Both advocates and policymakers continue to push for changes within the program to include preventive and restorative dental services.  The goal is to provide better access to essential oral healthcare for Medicare beneficiaries.

As the healthcare landscape continues to evolve, understanding the importance of Medicare dental benefits remains pivotal for individuals seeking comprehensive healthcare coverage.  Although the current scope of dental coverage in Medicare has many gaps, exploring supplemental options like Medicare Advantage plans or standalone dental coverage offer some help addressing oral health needs.

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Medicare Advantage  Enrollment Trends

There are continually increasing populations of people who become eligible for Original Medicare and Medicare Advantage plans each year in the United States. Since 2006, the amount of enrollees for Medicare Advantage plans has grown steadily.  In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population. This number also accounts for nearly half of the federal Medicare spending.  Let’s explore the Medicare Advantage enrollment trends.

In 2022, the average Medicare beneficiary has access to nearly 40 Medicare Advantage plans, which is the largest number of plans available in over a decade. This looks like 2.2 million new beneficiaries between 2021 and 2022, which is an eight percent increase in enrollees.

Employer Group Versus Individual Plans

In 2022, of the 28.4 million beneficiaries enrolled in Medicare Advantage.   The smallest percentage were enrolled in special needs plans, at a mere 16%. The next smallest group of beneficiaries was those enrolled in union-sponsored or employer-offered Medicare Advantage plans.   These account for 18% of the total. The largest group of beneficiaries by far is those in individual plans –  open for general enrollment.   This group makes up 66% of the 28.4 million beneficiaries. That is about two thirds of this group, or approximately 18.7 million people. Since 2021, that is an increase of about 1.3 million enrollees. However, the share of those in individual plans open for general enrollment has not increased.  It remains steady at about two thirds of the enrollment since 2018.

Medicare Advantage Plans By State

The share of Medicare beneficiaries who are enrolled in Medicare Advantage Plans varies greatly by state and has a very wide range of percentages across the country. However, in 25 of the states, at least half of those eligible for Medicare Advantage plans are enrolled in them. The more rural a state is, the more likely it is to have lower funding for Medicare and lower enrollment in Medicare Advantage plans. South Dakota, North Dakota, Wyoming, and Arkansas are the states with the lowest Medicare Advantage enrollment, which is less than twenty percent, or fewer than one fifth of eligible beneficiaries. Puerto Rico, on the other hand, has the highest percentage of enrolled beneficiaries, with 93% of Medicare beneficiaries also enrolled in a Medicare Advantage plan. This is largely thought to be due to policy choice, as many people in Puerto Rico are dually enrolled automatically in Medicare and Medicaid.

Licensed agents – Medicare Advantage Enrollment Trends

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What is a Medicare Advantage Plan

What is a Medicare Advantage Plan?  A Medicare Advantage plan is an insurance plan that insurance companies offer that have benefits similar to a group health insurance plan. (There are some differences however). Because these plans are referred to by different names, there is often confusion about what Medicare Advantage plans are.

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