Wellness checkups and health screening are all part of preventing serious health problems. With aging comes a higher chance of developing chronic conditions, which may require additional medical support.
In the United States, people often get health insurance through their employers. But what happens when you retire? If you’re over 65, you’re eligible for Medicare, a federal health insurance plan. Certain young people with disabilities and people with end-stage kidney failure are also eligible.
And if you’re looking for additional benefits, Medicare Advantage or Medicare Part C may be an option. Read on to learn the facts about Medicare Advantage and how this type of plan may benefit you.
Medicare Advantage, or Part C, is another form of Medicare coverage. Private insurance companies administer Medicare Advantage plans. These plans cover all medically necessary services covered by Original Medicare, with additional benefits like vision, hearing, and dental.
You’re eligible to join a Medicare Advantage Plan if you:
- live in the area of service of the plan you want to join
- have Medicare Part A and B
- are a U.S. citizen or a lawful resident
Most people with a Medicare Advantage plan — over 94%, according to the Kaiser Family Foundation — have some kind of dental coverage, and many have access to extensive coverage.
Many Medicare Advantage Plans offer routine dental coverage for preventive services provided by in-network dentists. Coverage varies from plan to plan, and some providers may offer comprehensive dental coverage.
Preventive and diagnostic dental services may include:
- routine cleanings
- dental exams
- dental X-rays
- fluoride application
Comprehensive coverage may include:
- deep cleanings
- crowns and bridges
- tooth extractions
- root canals
- partial and complete dentures
- IV sedation and general anesthesia
- dental implants
It’s important to never assume you have coverage. Always check with your provider. Your plan may have network or other restrictions.
Will I have to pay out of pocket?
Some plans won’t require you to pay out-of-pocket. But in some cases, you may have to pay for services. These may be in the form of copayments, deductibles, and coinsurance. Quite a mouthful, but let’s simplify:
- A copayment is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. This amount is usually printed on the health insurance card and covers a portion of your doctor’s visit or prescription.
- A deductible is the amount you pay yearly before your health plan begins to share the cost of covered services. This means that if your deductible is $1,500 per year, this amount is due before your health plan kicks in to cover services. Deductibles for family coverage and individual coverage are different.
- Coinsurance is the portion of the medical cost you pay after your deductible is met. Here’s an example. Say your coinsurance is 20%. If you meet your annual deductible in June but then need an MRI in September, you’ll need to pay 20% of the cost of that MRI.
- Medicare Advantage plans also have an out-of-pocket maximum. Maximum out-of-pocket is the most you could pay for covered medical expenses in a year. This amount includes money you spend on deductibles, copays, and coinsurance. As soon as you reach that limit, your health plan will pay your covered medical and prescription costs for the rest of the year. For 2022, that amount is $7,550, but plans may set lower limits.
Depending on the details of your plan, your plan’s monthly premium may cover up to 100% of your vision costs. The details of what your plan covers vary with the state, the company, and the policy you choose.
Vision care for seniors often includes prescription glasses. Some plans offer comprehensive coverage for most types of glasses, while others pay only a fraction of the cost leaving you to pay the rest.
Plan providers may place restrictions on how often you can see an optometrist, and some will pay only for the most basic frames and lenses.
Hearing coverage usually involves hearing exams and hearing aids. Some Medicare Advantage plans do provide limited or comprehensive coverage for hearing care. The details of plan coverage vary significantly on a state-by-state basis. Even within states, insurers have different offerings with various levels of care.
If you have a Medicare Advantage plan through a Health Maintenance Organization (HMO), hearing aids are only available through in-network providers. For plans with a Preferred Provider Organization (PPO), you can obtain hearing aids through in and out-of-network providers.
To find out what hearing coverage is covered by each plan in your state, visit the Hearing Loss Association of America.
When shopping for a Medicare Advantage plan, it can help to take a full inventory of your medical needs before choosing the plan that best meets your needs.
Sifting through information about health coverage can be overwhelming. If you need help deciphering complicated plan details or enrolling in a plan, you may want to consider working with a Medicare advisor.