Original Medicare (Medicare Part A and Part B) helps cover some hospital and medical costs for people age 65 and older and people younger than 65 who have a qualifying disability or medical condition.
In most cases, Medicare beneficiaries can replace their Original Medicare coverage by enrolling in a Medicare Advantage plan (Medicare Part C) that may provide additional benefits.
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Every Medicare Advantage plan must provide at least the same minimum benefits as Original Medicare, but they may include additional benefits not covered by Medicare Part A or Part B, such as:
Beginning in 2019, some Medicare Advantage plans began offering additional benefits such as transportation to doctor's appointments, bathroom grab bars and home-delivered healthy meals. And in 2020, some Medicare Advantage plans are offering new benefits to beneficiaries with chronic illnesses.
Below, Medicare expert John Barkett talks more about these new benefits and what to expect.
And unlike Original Medicare, which has no out-of-pocket maximum, Medicare Advantage plans limit how much you can pay out of pocket for care each year.
Many Medicare Advantage plans provide coverage for prescription drugs. In addition to your Medicare Advantage out-of-pocket costs, you’ll typically pay a copayment or coinsurance for covered drugs.
Specific drug costs will vary depending on the plan’s formulary (a list of drugs the plan covers) and the tier the drug falls into. Drugs in lower tiers generally cost less than drugs in higher tiers.
Some Medicare Advantage plans help cover common dental procedures such as:
Without dental coverage, you could be responsible for 100% of the costs for these services.
If you’re enrolled in a Medicare Advantage plan that covers dental, you will pay a coinsurance (a percentage of the total cost) for covered dental services once your deductible is met. Specific coinsurance amounts will vary by plan.
Some Medicare Advantage plans help cover routine vision care and vision products such as:
Without vision coverage, you could be responsible for 100% of the costs for these services.
If you’re enrolled in a Medicare Advantage plan that covers vision, you will pay a coinsurance for covered vision services once your deductible is met. Specific coinsurance amounts will vary by plan.
Some Medicare Advantage programs include SilverSneakers, a wellness program for seniors that encourages physical fitness and healthy living.
When you enroll in SilverSneakers, you gain access to:
To find Medicare Advantage plans in your area that includes SilverSneakers or coverage for vision, dental, vision and prescription drugs, speak with a licensed insurance agent at TTY Users: 711.
Original Medicare doesn’t cover everything. Medicare beneficiaries are responsible for some out-of-pocket costs, including (all costs for 2019):
*Most people do not pay a premium for Medicare Part A. If you pay for Part A in 2019, your premium could be up to $437 per month.
Additionally, there is no maximum for how much you could end up paying out of pocket for care, and Original Medicare does not cover routine dental care, routine vision care or prescription drugs.
Listed below are basic costs for people enrolled in Medicare Advantage.
As you shop for a Medicare Advantage plan that offers the benefits you're looking for, you can consider a plan from a number of different providers that may offer plans where you live.
Learn more about your plan options, which could include:
If you’re not satisfied with Original Medicare and would like an insurance plan that provides more coverage, call to speak with a licensed agent at today.
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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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