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Does Medicare offer Fewer Benefits than Private Insurance Companies?

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When it comes to your Medicare benefits, you have two choices about how you get them: through Original Medicare or Medicare Advantage. Your Medicare benefits under Original Medicare and Medicare Advantage are the same in many ways. But there are also many differences.

If you’re wondering about how the Medicare benefits compare between Original Medicare (Part A and Part B) and plans offered by private, Medicare-approved insurance companies, here’s what you should know.

Is Medicare Advantage private insurance?

Yes and no. Medicare Advantage plans are offered by private insurance companies that contract with Medicare. These plans are tightly regulated to make sure your Medicare benefits are at least the same as the benefits under Original Medicare.

Medicare Advantage plans may also have other benefits that make them more similar to private insurance plans you may get through your employer.

When you get your Medicare benefits through a Medicare Advantage plan, the government pays the insurance company a set amount each month for your health care. This creates competition among the insurance companies to offer extra Medicare benefits to attract more plan members.

What are some extra Medicare benefits that Medicare Advantage plans may offer?

Each insurance company decides which extra Medicare benefits (beyond Medicare Part A and Part B) they’ll offer, if any.

Most Medicare Advantage plans include prescription drug coverage. If you don’t have a Medicare Advantage plan, and you want prescription drug coverage, you need to enroll in a stand-alone Medicare Part D Prescription Drug Plan.

Many Medicare Advantage plans also include Medicare benefits for routine vision, dental, and hearing care. Some may charge an additional premium for these benefits, and there may be an annual cap on benefits for these services.

You may also find a Medicare Advantage plan that covers enrollment in the SilverSneakers program. SilverSneakers is a health and fitness benefit.  As a SilverSneakers member, you can visit any participating gym or fitness facility in the country. You can exercise, take classes, and join in fitness programs with other seniors.

What are the new supplemental Medicare benefits with Medicare Advantage?

Late in 2018, the Centers for Medicare & Medicaid Services (CMS) gave Medicare Advantage plans the green light to offer new Medicare benefits designed to help seniors age safely at home. Some plans already offer these new supplemental Medicare benefits, and many more are expected to add them in 2020. Please note that you may have to meet certain qualifications for each benefit.

The new supplemental Medicare benefits include things such as:

  • Nicotine replacement therapy (nicotine gum and patches, for example) for individuals who need help to quit smoking
  • Home meal delivery and/or grocery delivery for homebound plan members
  • Non-medical transportation to and from medical appointments
  • In-home health aide services for help with activities of daily living (eating, bathing, dressing, housekeeping)
  • Allowances for home safety equipment such as bathroom pull bars and wheelchair ramps
  • Allowances for over-the-counter medications and home health devices such as thermometers, blood pressure cuffs, and scales

Plans may not charge an extra premium for the new supplemental Medicare benefits, but they may impose monthly or annual caps on benefits. For example, a plan may pay for up to 10 non-medical trips per year, or $25 a month for over-the-counter medications and devices. There may be other restrictions on these benefits. For example, you may need to use a specific provider or home health agency contracted with your insurance company.

Do I still get Medicare protections if I get my Medicare benefits through a Medicare Advantage plan?

When you have a Medicare Advantage plan, you are still a Medicare beneficiary. You’re still entitled to the same rights as anyone else enrolled in the Medicare program.

If you have a problem with your plan or a provider contracted with your plan, you can file a complaint with Medicare. If you disagree with any decisions made by a Medicare health plan, you may request a Medicare review. You don’t lose any of your protections when you get your Medicare benefits through Medicare Advantage.

Medicare conducts careful oversight of Medicare Advantage plans and maintains a rating system so you can see how each plan performs compared to other plans available in your area.

To look for Medicare Advantage plans in your area, enter your zip code on this page.

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