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What benefits does my Medicare Advantage plan cover?

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Medicare Advantage plans are a way to get your Medicare benefits through a private insurance company. By law, Medicare Advantage plans must cover everything that Original Medicare covers, which includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage plans often cover additional benefits that Original Medicare generally doesn’t cover, including prescription drugs you take at home and other extra benefits.

Medicare Advantage plans can make it easy to get all your coverage under one convenient plan, rather than piecing together coverage with Original Medicare, plus Medicare Part D, plus Medicare Supplement.

What hospital benefits do Medicare Advantage plans cover?

Medicare Advantage plans generally cover:

  • Inpatient care in a hospital which you need to treat your illness or injury
  • Skilled nursing facility care following a qualifying hospital stay
  • Limited home health care including part-time skilled nursing care, occupational therapy, and speech-language pathology services.

Medicare Advantage plans generally don’t cover hospice care, but don’t worry; you’ll still be covered for hospice by Medicare Part A.

What medical benefits do Medicare Advantage plans cover?

Medicare Advantage plans generally cover:

  • Outpatient doctor visits and check-ups
  • Ambulance rides if transportation in another vehicle could endanger your health
  • Durable medical equipment, such as walkers and wheelchairs
  • Inpatient and outpatient mental health treatment

What prescription drug benefits do Medicare Advantage plans cover?

Original Medicare (Part A and Part B) generally doesn’t cover prescription drugs you take at home. Most Medicare Advantage plans cover prescription drugs.

While your Medicare Advantage plan may not cover all prescription drugs, they usually do cover a variety of prescription drugs to treat many different conditions.

To learn exactly what medications your Medicare Advantage plan covers, ask for the plan’s formulary, or list of covered prescription drugs. The formulary generally spells out the prescription drugs covered and the “tier” they are on, which will determine the copayment or coinsurance you pay.

If your doctor believes that you need a prescription drug that is not on your Medicare Advantage plan’s formulary, he or she can help you request an exception.

Medicare Advantage plans may also cover over the counter drugs, which Original Medicare also generally doesn’t cover.

What extra benefits do Medicare Advantage plans cover?

Original Medicare has some gaps in coverage that your Medicare Advantage plan may cover. This includes coverage for:

  • Routine vision care include routine eye exams, contacts, eyeglass frames, and eyeglass lenses
  • Routine hearing care including fittings for hearing aids
  • Comprehensive dental care including coverage for routine exams, diagnostic and restorative services
  • Additional smoking and tobacco use cessation counseling
  • Fitness benefits called “SilverSneakers” which may include a free gym membership

This is not a complete list. Not every Medicare Advantage plan offers extra benefits.

What are the financial benefits of a Medicare Advantage plan?

Some Medicare Advantage plans may come with a $0 monthly premium, although you generally still have to pay your Medicare Part B premium.

The biggest financial benefit of a Medicare Advantage plan may be that all Medicare Advantage plans are required to have an annual out-of-pocket maximum. This means that even if you have a major health problem and receive extensive care, you will only pay a certain amount out of pocket before your Medicare Advantage plan pays  your covered benefits for the rest of that year. The out-of-pocket maximum varies among plans. Original Medicare doesn’t have an out-pocket maximum.

To find a Medicare Advantage plan in your area, enter your zip code on this page.

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