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.