- Medicare Advantage (Part C) combines Medicare Part A and Part B coverage with additional benefits like dental, vision, hearing, and others.
- Medicare Advantage is sold by private insurance companies.
- When purchasing a Medicare Advantage plan, your costs will depend on where you live and the specific plan you choose.
If you’re in the market for a Medicare plan, you may be wondering what Medicare Advantage (Part C) plans cover.
With a Medicare Advantage plan, everything under original Medicare is included, such as hospital and medical insurance. However, most Medicare Advantage plans also cover additional health-related services, such as prescription drugs, vision, and dental.
In this article, we will explore what Medicare Advantage is, what it covers, what it costs, and when you might consider a Medicare Advantage plan.
Medicare is a type of government-funded medical insurance available to people over age 65 in the United States.
There are different types of Medicare plans to choose from depending on the coverage you’re looking for. Original Medicare covers:
- Medicare Part A. Part A covers hospital services, nursing facility care, home health care, and hospice care.
- Medicare Part B. Part B covers preventive healthcare and medically necessary services for health conditions.
Medicare Advantage plans, also known as Medicare Part C plans, are insurance plans that offer Medicare with additional coverage. Medicare Advantage is offered by private insurance companies that have a contract with Medicare.
You qualify for Medicare Advantage if you already have Medicare parts A and B.
There are various types of Medicare Advantage plans to choose from depending on your needs. They include:
- Health Maintenance Organization (HMO). HMO plans stipulate that you can only seek services from doctors and facilities that are in-network. Specialists require out-of-network referrals.
- Preferred Provider Organization (PPO). PPO plans charge different rates for doctors, providers, and hospitals depending on whether they’re in-network. You’ll pay more for out-of-network services.
- Private Fee-for-Service (PFFS). PFFS plans allow you to receive services from any provider as long as they accept the payment terms and conditions of your PFFS plan.
- Special Needs Plans (SNP). SNPs are offered to certain groups of people who require long-term medical care for chronic conditions.
- Medicare Medical Savings Account (MSA). MSA plans combine a high deductible health plan with a medical savings account where Medicare deposits money to be used for medical-related services.
Medicare Advantage plans offer both hospital and medical insurance coverage and additional coverage. Depending on the type of plan you choose, you may be covered for:
- Hospital insurance (Part A). This covers inpatient hospital visits and hospital-related services, short-term nursing facility care, medically necessary home health care visits, and end-of-life hospice care.
- Medical insurance (Part B). This covers preventive, diagnostic, and treatment-related services for medical conditions. Many Medicare Advantage plans cover medical transportation as well.
- Prescription drug coverage. This isn’t usually offered under original Medicare. Almost all Medicare Advantage plans offer prescription drug coverage.
- Dental, vision, and hearing. This includes non-medically necessary coverage, which isn’t offered under original Medicare. Most Medicare Advantage plans differ in coverage of these options.
Helping someone choose a plan?
If you’re helping a family member or friend choose a Medicare Advantage plan, you’ll want to consider the following:
- What type of coverage do they need? Are they looking for only prescription drug coverage, or are they interested in dental or vision coverage as well? Are they interested in other health-related services?
- What type of out-of-pocket costs can they afford? Consider whether an MA plan covers any premiums or deductibles, the monthly and yearly cost of the plan itself, and how often and to what extent medical care is needed.
- What type of Medicare Advantage plan are they interested in? Does an HMO plan serve their needs best, or are they better off with a PPO or MSA plan? Do they have special long-term costs that can only be met with an SNP plan?
- What other factors could impact their medical needs? Do they travel or require out-of-state care for certain conditions? Are they predisposed to certain conditions that will require future referrals or out-of-network visits?
With original Medicare, you’re required to pay an out-of-pocket monthly premium for Medicare Part B. This premium is adjusted each year and is calculated based on your income tax filed for 2019.
Medicare Part B also has a yearly out-of-pocket deductible. After meeting this deductible, you’re required to pay 20 percent of all Medicare-approved services.
When you sign up for a Medicare Advantage plan, your costs may look a little different. Many plans cover a portion of your Medicare Part B monthly premium.
A Medicare Advantage plan might also include its own monthly premium and yearly deductible in addition to your Medicare Part B costs.
One advantage of a Medicare Advantage plan is that there’s a yearly cap for most other out-of-pocket costs, which may help lower your overall costs.
The total cost of a Medicare Advantage Plan is generally determined by premiums, deductibles, copayments, how often and where you seek services, the types of services you need, and whether you receive Medicaid.
Given all these factors, there’s no one specific cost for a Medicare Advantage plan. These are all important things to consider when you compare plans.
While a Medicare Advantage plan may seem like an easy choice for Medicare coverage, consider the pros and cons:
Advantages of Medicare Advantage
- Many Medicare Advantage plans offer additional coverage that original Medicare doesn’t offer, like prescription drugs, dental, vision, hearing, and more.
- Medicare Advantage plans offer in-network care, which can be more easily coordinated.
Researchhas shown that Medicare Advantage plans may result in lower prices on medical services compared with original Medicare.
Disadvantages of Medicare Advantage
- Depending on which plan you choose, you may be limited in your provider options.
- If you need to see a specialist for certain conditions, you may need a referral first.
- If you travel, your out-of-town services may not be covered.
You may benefit from a Medicare Advantage plan if you’re looking to receive full Medicare coverage, plus more. If you’re interested in prescription drug coverage and yearly dental and vision appointments, a Medicare Advantage plan is a great option.
If you have chronic health conditions, an SNP can help cover some long-term medical costs. You may also benefit from an MSA plan if you want to have funds for a variety of medical services throughout the year.
However, if you feel that you don’t need additional coverage for things such as dental, vision, hearing, or prescription drugs, a Medicare Advantage plan may not suit you.
The same applies if you want freedom to choose your own providers. If you need out-of-town coverage, a Medicare Advantage plan may not help cover these unexpected medical costs.
Medicare Advantage plans offer medical coverage above and beyond what Medicare parts A and B can offer. This may include additional health services, such as prescription drugs, vision, dental, and more.
While some Medicare Advantage plans have more out-of-pocket costs, others will help you save on long-term medical costs.
Not everyone needs a Medicare Advantage plan, so consider your medical and financial needs before choosing what type of Medicare is best for you.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.