Medicare 101: Your Guide to Additional Benefits

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.

Couple looking out of a window

Additional benefits with a Medicare Advantage plan

In most cases, Medicare beneficiaries can replace their Original Medicare coverage with a Medicare Advantage plan (Medicare Part C) that may provide additional benefits. 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:

  • Prescription drug coverage
  • Dental coverage
  • Vision coverage
  • Health and wellness programs

Beginning in 2019, some Medicare Advantage plans may begin offering additional benefits such as transportation to doctor's appointments, bathroom grab bars and home-delivered healthy meals.

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.

Prescription drug coverage

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.

Medicare dental coverage

Some Medicare Advantage plans help cover common dental procedures such as:

  • Routine preventive and diagnostic care such as teeth cleanings
  • Basic dental procedures such as fillings and root canals
  • Major dental procedures such as bridges

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.

Medicare vision coverage

Some Medicare Advantage plans help cover routine vision care and vision products such as:

  • Basic preventive care
  • Eyeglass lenses
  • Eyeglass frames

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.

SilverSneakers

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:

  • Community fitness programs
  • A network of gyms
  • A variety of fitness classes
  • A community of your peers

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 costs

Original Medicare doesn’t cover everything. Medicare beneficiaries are responsible for some out-of-pocket costs, including (all costs for 2019):

  • Part B premium
    $135.50 a month, though you could pay more if you have a higher income
  •  
  • Part A deductible
    $1,364 per benefit period
  •  
  • Part B deductible
    $185 per year
  •  
  • Part A coinsurance
    $0 for days 1-60 spent in the hospital, $341 per day for days 61-90 spent in the hospital, $682 per each “lifetime reserve day” for days 91 and beyond spent in the hospital
  •  
  • Part B coinsurance
    20 percent of the Medicare-approved amount for most doctors services after your deductible is met

*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.

Medicare Advantage costs

Listed below are basic costs for people enrolled in Medicare Advantage.

  • Part B premium
    Even with Medicare Advantage, you will have to pay the Medicare Part B premium.
  •  
  • Medicare Advantage premium
    Medicare Advantage premium amounts vary from plan to plan, but some MA plans have monthly premiums as low as $0.1
  •  
  • Deductibles and coinsurance
    Medicare Advantage deductibles and coinsurance vary by plan. You can speak with a licensed insurance agent at   TTY Users: 711 24 hours a day, 7 days a week to learn more.

Compare Medicare Advantage plans from a number of brands

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:

Learn more about Medicare Advantage plans today

If you’re not satisfied with Original Medicare and would like an insurance plan that provides more coverage, speak with a licensed agent at   TTY Users: 711 24 hours a day, 7 days a week to find a Medicare Advantage plan that works for you.

 

You must continue to pay your Part B premium. $0 premium plans may not be available in all areas.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.