3 things to know about what Medicare Advantage plans cover:
1. All plans include at least the same coverage as Original Medicare (Part A and Part B).
2. Most Part C plans provide prescription drug coverage.
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3. Some plans provide coverage for dental, vision, and wellness programs.
All Medicare Advantage plans include the same standard benefits as Medicare Part A and Part B.
Medicare Part C plans are required by law to cover all of the above benefits. The only exception is coverage of hospice care.
Medicare Advantage plans do not cover hospice care. However, you will still get hospice care through your Original Medicare benefits, even if you are enrolled in a Medicare Advantage plan.
Most Medicare Advantage plans provide prescription drug coverage.
Some Medicare Advantage plans may provide extra benefits such as:
Individual plan benefits and availability can vary depending on where you live and the type of Part C plan you have. Not all of these extra benefits will be available with Medicare Advantage plans in all areas.
Medicare Advantage plan benefits can change from year to year, so it's important to check with your plan each year to make sure it is still the best Medicare Advantage plan for your unique needs.
In addition to the Durable Medical Equipment (DME) that Original Medicare covers, Medicare Advantage plans may cover the following, depending on the particular plan:
Some Medicare Advantage plans may also provide coverage for equipment like wheelchair ramps and air conditioners for people with asthma.
Ask a licensed insurance agent what additional benefits may be covered by the plans you are considering.
Some Medicare Advantage plans may include prescription drug coverage.
In 2019, 90% of Medicare Advantage plans offered prescription drug coverage.1
Each plan has its own formulary, which is a list of drugs and brand names the plan provider will cover.
In a Medicare formulary, drugs are separated into different tiers.
The coverage for each category of drug may vary from one plan to the next.
Before enrolling, you should review a plan’s formulary to ensure that your particular medications are covered.
If your Medicare Advantage plan does not provide prescription drug coverage, you may be able to enroll in a Medicare Part D prescription drug plan (PDP).
However, some Medicare Advantage plans, like HMO plans and PPO plans, have rules which prohibit you from enrolling in a PDP.
While Medicare Part B offers some coverage related to vision, it doesn't cover routine eye exams or glasses. Some Medicare Advantage plans, however, offer these benefits.
Part C plans that include vision coverage may include benefits for services and items such as:
Some Medicare Advantage plans even offer coverage for designer eyeglasses such as glasses from Warby Parker.
Medicare Part B similarly does not typically cover most dental care services.
Some Medicare Part C plans, however, may offer dental benefits such as:
Hearing loss is among the most common age-related health complications.
While Original Medicare does not provide any coverage for routine hearing exams or hearing aids, some Medicare Advantage plans may offer these benefits.
Medicare Advantage plans that cover hearing care may offer benefits such as:
Another unique benefit that some Medicare Part C plans may offer is membership to gyms and wellness programs.
Among the most popular of these types of fitness programs is SilverSneakers, which is a fitness program catered to older adults.
SilverSneakers has thousands of participating locations across the U.S. and includes access to exercise classes, outdoor activities, recreational sports leagues, yoga, swimming pools and other gym facilities and much more.
In recent years, the Centers for Medicare & Medicaid Services (CMS) approved new additional benefits that can be offered by Part C plans.
Some of these new benefits can include things like:
A licensed insurance agent can help you find 2021 Medicare Advantage plans available in your area that offer the benefits you need.
Enrolling in a Medicare Advantage plan does not mean that you are disenrolling from Original Medicare. In fact, you must enroll in Original Medicare in order to belong to a Medicare Advantage plan.
You will still technically have Original Medicare (and in most cases, you must continue to pay your Medicare Part B premium), but your health insurance coverage will come from your Medicare Advantage plan carrier.
Before you enroll in a particular Medicare Advantage plan, you should carefully review the benefits and the out-of-pocket costs it can help cover.
After you have enrolled, you can always check with your Medicare Advantage plan provider to see if a particular medical service is covered. If you receive treatment that is not medically necessary and not covered by your Medicare Advantage plan, you may have to pay all of the costs.
You can request a written advance coverage decision from your insurance company to ensure that the service will be considered medically necessary and will be covered.
To learn more about Medicare Advantage plans and to find plans in your area, call a licensed insurance agent today or compare plans online.
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1 Fugelsten Biniek, J. et al. (Oct. 29, 2020). Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.
2 Medicare evaluates plans based on a 5- star rating system.
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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