Medicare Advantage is a type of health insurance coverage you can buy from private companies that contract with Medicare. It provides all the benefits of traditional Medicare coverage, plus additional benefits such as vision and dental care.
Private companies approved by Medicare offer Medicare Advantage plans. You can enroll in this plan anytime during the year. You can enroll directly with the plan or through an agent, broker, or Medicare counseling and assistance program.
If you have questions about your coverage or services, call the customer service number on your membership card. Below are the Medicare Advantage basics:
How Do I Choose a Plan?
There are many things to consider when choosing Medicare Advantage plans, including the following:
Cost
The monthly premium varies depending on where you live and your chosen plan. Some plans offer lower premiums with higher out-of-pocket costs for services like doctor visits or prescription drugs. You should compare these costs carefully before deciding which plan is best for you.
Benefits
Different plans offer different levels of coverage for additional services (like doctor’s office visits or prescription drugs). Medicare Advantage plans must provide all benefits required by federal law, but they can also offer additional benefits that traditional Medicare does not cover.
Compare Plans
Compare plans using the Medicare Plan Finder, a tool provided by Medicare that will help you compare all available programs in your area. This tool allows you to search for and compare the benefits of different plans side by side before deciding which one works best for you.
Consider What They Cover
Your plan may offer extra benefits like dental or vision coverage, prescription drug coverage, and more—these can help you save money on health care costs in addition to what Medicare provides (like prescription drugs). But these extras typically come at an additional expense beyond your monthly premium payment.
What Kinds of Health Services Do Medicare Advantage Plans Cover?
The plans cover Medicare Part A and Part B benefits and other health care services.
Medicare Advantage plans provide the following:
- Medicare Part A hospital insurance (Hospital Insurance, or HI) coverage. These plans can provide this coverage the same way original Medicare does. However, some Medicare Advantage plans may offer extra benefits through a “cost plan” arrangement where you pay a monthly premium and lower copays for hospital stays.
- Medicare Part B medical insurance (Medical Insurance, or MI). Medicare Advantage plans also must provide this coverage in the same way that original Medicare does.
- Medicare Part D prescription drug coverage (Prescription Drug Coverage, or PDC). All Medicare Advantage plans must include PDC as part of their benefits package to be certified by Medicare.
Some Medicare Advantage plans have additional benefits that traditional Medicare doesn’t cover. These extra benefits include:
- Dental – Most Medicare Advantage plans include dental coverage, and some offer an enhanced dental range.
- Vision – Many Medicare Advantage plans offer enhanced vision coverage. Some may pay for eyeglasses or contact lenses, while others provide vision care services such as eye exams, laser surgery, and treatment for eye diseases like macular degeneration.
- Hearing – Most Medicare Advantage plans include hearing aid coverage, but there are no federally mandated rules about what is covered. Plans that do cover hearing aids may limit the number of devices you can get over time or charge a copayment for each device you get.
What’s The Difference Between How a Medicare Advantage Plan Covers Doctors and How Original Medicare Covers Doctors?
Medicare Advantage plans vary significantly in their coverage of doctors and outpatient services. Some plans cover all Medicare-covered benefits, while others may cover some but not all. With Original Medicare, you choose your doctors and hospitals and decide how much to spend out-of-pocket each year.
With a Medicare Advantage plan, you can keep using the same doctors and hospitals as long as they accept your plan’s network. If you relocate outside the plan’s service area, you might need to switch hospitals or doctors. When choosing a Medicare Advantage plan, ensure it covers the doctors and hospitals where you live.
When comparing plans, it’s essential to understand how they work with your current coverage. For example:
If you have a supplemental policy that pays for extra out-of-pocket costs, such as copayments or coinsurance (deductibles), check whether it will continue to pay if you enroll in this plan that doesn’t cover everything.
If you currently a prescription drug coverage through Original Medicare or another insurance plan (such as an employer group health plan), ask whether the new policy will still cover those prescriptions before enrolling in it—or if you’ll need to switch medications first.
Benefits of Enrolling in Medicare Advantage Basic
Here are some of the benefits of enrolling in Medicare Advantage Basic:
- Choice of Doctors
If you have a doctor that you want to see, you can continue seeing them through their network. This means they can continue treating you even if they are not part of the traditional Medicare program.
- No Waiting Periods
There are no waiting periods for getting treatment or medications for Medicare Advantage Basic. Once your application has been accepted and approved by the government, you can start receiving services immediately without waiting for anything else.
- Your Doctor Can See You Any Time
Since there is no waiting period when getting treatment or medications from any doctor, they can see you anytime they want during regular office hours since they do not need prior authorization from anyone before seeing their patients.
- Preventive Care Services and Screenings
Your plan covers some preventive services like cancer screenings at no cost to you (depending on your plan). Medicare Advantage plans also cover other preventative services like flu shots, blood pressure tests, and cholesterol tests at no cost to you (depending on your plan).
In Conclusion
You can’t go wrong with Medicare Advantage Basic. The insurance company pays the doctor first, then sends you the bill. You pay the Medicare Advantage plan’s monthly premium, usually less than what traditional Medicare would cost, and then any copays or deductibles apply. It’s not nearly as complicated as it sounds!