Medicare Advantage (Medicare Part C) provides all-inclusive coverage for Medicare recipients who wish to have their Part A, Part B, and additional benefits bundled within one plan. MA plans are required to provide the same benefits as Original Medicare, but many offer additional benefits, such as prescription drug coverage, vision and dental, care, and wellness programs. Medicare Advantage plans are sold by private insurance companies that contract with Medicare, and costs and benefits may vary from plan to plan.
Medicare Advantage Benefits
Medicare Part C plans include Part A (Hospital Insurance) and Part B (Medical Insurance) benefits, which can include an array of coverage for medical expenses. Medicare Part A is designed to cover inpatient hospital expenses, as well as coverage for care in a skilled nursing facility, hospice, or home health care. In addition, this part covers surgeries and other necessary medical services that are offered in these inpatient facilities.
Medicare Part B may help cover outpatient care, including procedures or services that are needed to diagnose or treat a current medical condition or those that are needed to prevent a future health issue from occurring, including injury and illness. Some of the services that are covered by Medicare Part B plans may include durable medical equipment (DME) needs, physician visits and follow-ups, ambulance services, clinical research studies, mental health appointments, and more.
Medicare Part D helps cover the costs of prescription medications. Prescriptions can be expensive, especially when taken for long periods of time or in large quantities. The costs of medications prescribed by a physician are not covered by Original Medicare. Original Medicare recipients must enroll in a stand alone Prescription Drug Plan (PDP) to have prescription drug benefits. Many Medicare recipients choose to enroll in a Medicare Advantage plan that includes drug coverage.
A Medicare Advantage plan provides an all-in-one option. Many Medicare Advantage plans also include coverage for dental and vision care, hearing services, fitness center memberships, and more.
How Does a Medicare Advantage Plan Work?
These plans are approved by and have to adhere to strict rules that are set by Medicare. There are several options to choose from, including Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). If you are enrolled in an HMO, for instance, you may need to see physicians within your plan’s network. You may need to request a referral before seeing a specialist and visit specific facilities when seeking care. Plan benefits and costs can change on a yearly basis. The associated costs of these plans can vary significantly, and they may require a monthly premium, include a yearly deductible, and require copayments for services.
Many Medicare Advantage plans include prescription drug coverage, and are sometimes referred to as MA-PDs. Each plan has its own formulary, or list of covered drugs, and its own tiers of pricing.
Medicare Advantage plans provide a option for Medicare beneficiaries. These plans can vary significantly in cost and the services provided, so it is important to consider your specific needs when choosing a plan and compare plans. Take time to review your options and find the plan that is right for you.
Medicare Part D: Medicare Prescription Drug Coverage