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What Do Medicare Advantage Plans Cover?

Happy senior man looking through telescope as representing his search for what Medicare Advantage covers.
Medicare Advantage is also called Medicare Part C. These plans are offered by private insurance companies who are approved by the federal Medicare program to offer them.

Medicare Advantage Plans Cover – You’ve seen the TV commercials or heard about Medicare Advantage on your local radio station. These plans brag about all the extra benefits they have for a very low cost. But what exactly are those extra benefits? Let’s find out what Medicare Advantage covers.

What is Medicare Advantage?

Medicare Advantage is also called Medicare Part C. These plans are offered by private insurance companies who are approved by the federal Medicare program to offer them. Every Part C plan must include at least as many benefits as are found in Parts A and B of Original Medicare (except the hospice portion). If you enroll in Part C, your benefits from Parts A and B will be provided by the private insurance company instead of the government. Most Advantage plans include the extra benefits you hear so much about.

There are six different kinds of Medicare Advantage plans, and you’ll need to know how each one works before you enroll. We won’t’ go into those details here, but the six types of plans include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point-0f-Service (HMO-POS)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNP)
  • Medical Savings Account (MSA)
Senior couple discussing what their Medicare Advantage covers.
There are six different kinds of Medicare Advantage plans, and you’ll need to know how each one works before you enroll.

What extra benefits do Part C plans include?

Now let’s talk about the extra benefits you might find in a Medicare Advantage plan.

First, it’s important to note that not all plans offer the same thing. Since they’re run by private insurance companies, you won’t find two plans that are the same. You’ll need to review the policy’s summary of benefits to find out what is included in each plan.

Some additional benefits in Part C plans might include:

  • Prescription drug coverage
  • Routine and restorative dental care
  • Vision exams and eyeglasses
  • Hearing exams and hearing aids
  • Transportation to and from doctor’s appointments
  • Meal delivery after hospitalization
  • Gym memberships and fitness programs
  • Home risk assessments
  • Over-the-counter medication stipends
  • Rewards and incentives for preventive care services

It’s easy to see why so many people want the extra benefits that are included in Medicare Advantage plans.

There are even some Advantage plans that offer a “Part B giveback,” which is a program that reduces your Part B premium. However, those plans aren’t all that common and are not available everywhere. If you do find a Part C plan with Part B premium reductions, the reduction could be all or some of your Part B premium.

One last thing about the extra benefits. If a Medicare Advantage plan includes prescription drug coverage, we refer to these as MAPD plans. You will need to consult the plan’s drug formulary to find out if your current medications are covered and how much you’ll pay for each. If your Advantage plan does not come with prescription drug coverage, you may be able to enroll in a separate Part D prescription drug plan. However, there are some limitations that apply.

How much do Medicare Advantage plans cost?

With all these additional benefits, you might assume you’ll be paying a higher premium. Surprisingly, that’s not the case. Some Medicare Advantage plans offer premiums for as little as $0 per month.

How can they offer such low premiums? It goes back to the types of Advantage plans we talked about earlier. Each kind is going to require the enrollee to utilize a specific provider network. For example, if you enroll in an HMO plan, you’ll need to receive care from providers and facilities that participate in that specific HMO plan. If you go outside of the HMO network, you will be responsible for the full cost (except in emergency situations).

Some see this limitation as a negative. You’ll have less freedom when it comes to choosing providers, and there are other rules you must follow. However, if you understand how your plan works and how to get the most of your coverage, Medicare Advantage plans can have excellent value.

We’ve barely scratched the surface of everything you’ll need to know about Medicare Advantage before you enroll. There are big differences between these plans and Medigap plans, which are the other option you have to supplement your Original Medicare benefits.

You should take the time to research each type of plan and talk about your options with one of our licensed insurance agents. Our agents specialize in all things Medicare and can help you learn the ins and outs of each type of plan. Our services come at no additional cost to you, so there is absolutely no reason not to work with us!

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