Medicare Insurance

Medicare Advantage

Medicare Advantage plans typically cover benefits that Original Medicare doesn’t like prescription drugs, dental and vision, hearing aids, and exams.

Medicare Advantage can cover things that Original Medicare doesn’t.

Medicare Advantage is the private portion of Medicare, sometimes called “Part C” but not often these days. Advantage plans, by law, cover everything that Original Medicare covers. The difference is that these plans are sold by private companies.

And because Medicare Advantage is sold by private companies, these plans have more leeway in what they offer.

Medicare Advantage can cover things like:

  • Prescription drugs
  • Hearing aids and exams
  • Dental and vision services
  • Transportation
  • Post-hospital meal delivery
  • Gym memberships
  • Wheelchair ramps for your home
  • Pest control services

Think we’re making up those last couple bullet points? Nope.

Under recent rules, Medicare Advantage plans can even cover some non-medical services designed to make life a little easier if you have certain health issues, like mobility concerns. Plans have discretion here, so it’s not like every single Advantage plan covers these kinds of services.

But it’s possible. And possible is certainly better than the firm no that Original Medicare offers.

Original Medicare probably won’t cover all the care that you need as you get older.

Part A covers hospital and skilled nursing facility care. Part B covers medically necessary outpatient care. Beyond that, Original Medicare is pretty limited. There’s no coverage for prescription drugs, for example.

Plus, Original Medicare comes with a 20% coinsurance for Part B services with no cap in place to limit what you pay out of pocket for the year.

Medicare Advantage plans, by contrast, have a cap in place to limit your out-of-pocket spending for the year.

Cost-sharing is different, too.

Instead of a 20% flat rate across the board, Advantage plans typically have different fees depending on the service type. You might pay $10 to see your primary care doctor, for instance, or a $200 copay for emergency room visits.

But Advantage plans cost more, right?

Actually, probably not. It’s true that some Medicare Advantage plans have an additional premium. These vary by plan and where you live. But some Advantage plans actually don’t have an extra premium. You might pay $0 extra a month for all the benefits of a private Medicare plan.

And by “extra,” we mean a premium on top of what you’ll already pay with Original Medicare.

Because no matter which route you take — Original or Advantage — you’ll always pay your Part B premium. (And if you’re in the very small percentage of people who have a Part A premium, you’ll pay that, too.)

Let’s sum up:

  • Medicare Advantage plans cover at least everything that Original Medicare (Parts A & B together) covers. That’s by law.
  • Beyond this requirement, Medicare Advantage plans typically cover benefits that Original doesn’t. These might include prescription drugs, dental and vision, hearing aids and exams, and a variety of other benefits.
  • Costs vary. Medicare Advantage plans set their own deductibles and cost-sharing amounts. But they also include a cap on out-of-pocket expenses for the year.
  • You may have a monthly premium, or you might not. Regardless, you’ll always pay any premiums you would under Original Medicare.

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