Are you curious about what Medicare Advantage plans cover? Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies as an alternative to Original Medicare. These plans provide additional benefits beyond what is covered by other parts of Medicare: Parts A and B.
In this article, we’ll explore what Medicare Advantage plans cover to help you determine if it’s the right choice for your healthcare needs.
Explanation of Medicare Advantage plans
Medicare Advantage plans are required to provide all the benefits covered by Original Medicare (Part A and Part B), but they may have different rules, costs, and restrictions. For example, some plans may have lower monthly premiums, but higher out-of-pocket costs for services like doctor visits and hospital stays. Other plans may have higher monthly premiums, but lower out-of-pocket costs.
Medicare Part A and Part B Benefits Covered by Medicare Advantage Plans
Given below are the components of Medicare Part A and Part B that are covered under Advantage Plans:
Inpatient Hospital Care
Inpatient hospital care is one of the Medicare Part A benefits covered by Medicare Advantage plans. This benefit covers the care you receive when you’re admitted to a hospital as an inpatient. Medicare Advantage plans must cover the same hospital services that are covered under Original Medicare, but the costs and rules may vary depending on the plan.
When you’re admitted to a hospital as an inpatient, Medicare Advantage plans generally cover:
Hospital Stays
Medicare Advantage plans cover your room and board, as well as any general nursing care you need during your hospital stay. The length of your stay will depend on your medical needs and the plan’s rules. Some plans may have limits on the number of days you can stay in the hospital, while others may not have any limits.
Skilled Nursing Facility Care
If you require additional care after being discharged from the hospital, Medicare Advantage plans may cover care in a skilled nursing facility. This includes care you receive in a nursing home, rehabilitation center, or other facilities that provide skilled nursing care. The length of your stay and the services covered will depend on your medical needs and the plan’s rules.
Doctor Visits
Medicare Advantage plans generally cover visits to your primary care physician or a specialist. The cost of these visits, including any copayments or coinsurance, will depend on your plan’s rules.
Preventive Services
Medicare Advantage plans cover a range of preventive services, including flu shots, cancer screenings, and wellness visits. These services are typically covered at no cost to you, but the specific services and rules may vary depending on your plan.
Diagnostic Tests and Imaging
These tests are used to diagnose medical conditions and determine the appropriate treatment. When you receive diagnostic tests and imaging services under a Medicare Advantage plan, you may have coverage for the following:
Lab Tests
Medicare Advantage plans cover a range of lab tests, including blood tests, urinalysis, and other diagnostic tests. The cost of these tests, including any copayments or coinsurance, will depend on your plan’s rules.
X-Rays
Medicare Advantage plans cover X-rays, which are used to produce images of the inside of the body. The cost of these services, including any copayments or coinsurance, will depend on your plan’s rules.
CT Scans
Medicare Advantage plans cover CT scans, which are used to produce detailed images of the inside of the body. The cost of these services, including any copayments or coinsurance, will depend on your plan’s rules.
MRI Scans
Medicare Advantage plans cover MRI scans, which use strong magnets and radio waves to produce detailed images of the inside of the body. The cost of these services, including any copayments or coinsurance, will depend on your plan’s rules.
PET Scans
Medicare Advantage plans may cover PET scans, which are used to produce images of the inside of the body and measure metabolic activity. The cost of these services, including any copayments or coinsurance, will depend on your plan’s rules.
Preventive Care and Screenings
These services are used to help prevent illness or detect health problems at an early stage when they are most treatable. The coverage includes:
Annual Wellness Visit
Medicare Advantage plans cover an annual wellness visit, which includes a review of your medical history, medications, and health status. The visit may also include a personalized prevention plan based on your health needs and risk factors.
Immunizations
Medicare Advantage plans cover a range of immunizations, including flu shots, pneumonia vaccines, and hepatitis B vaccines. These services are typically covered at no cost to you.
Cancer Screenings
Medicare Advantage plans cover a range of cancer screenings, including mammograms, Pap tests, and colonoscopies. The frequency and coverage of these services may vary depending on your age, gender, and other factors.
Cardiovascular Screenings
Medicare Advantage plans cover cardiovascular screenings, including blood pressure and cholesterol checks. These services are used to detect heart disease and other cardiovascular conditions.
Additional Benefits Covered by Medicare Advantage Plans
In addition to the benefits covered by Medicare Part A and Part B, Medicare Advantage plans may offer additional benefits that are not covered by Original Medicare. These additional benefits can vary depending on the plan and may include:
Prescription Drug Coverage
Medicare Advantage plans that offer prescription drug coverage (also known as Medicare Part D) can help you pay for the cost of prescription medications. The specifics of the coverage can vary between plans, but most plans have a formulary or a list of covered drugs. Plans may also have different costs associated with the coverage, such as a monthly premium, deductible, copayment, or coinsurance.
Dental Care
Many Medicare Advantage plans offer dental care benefits, such as routine cleanings, X-rays, and fillings. Some plans may also cover more extensive dental procedures, such as root canals, extractions, or dentures. However, the specifics of the coverage can vary between plans, such as the number of cleanings covered per year or the maximum amount of coverage per year.
Vision Care
Some Medicare Advantage plans offer vision care benefits, including routine eye exams, eyeglasses, and contact lenses. Some plans may also cover more extensive vision care procedures, such as cataract surgery. However, the specifics of the coverage can vary between plans, such as the frequency of exams covered or the amount of coverage for glasses or contacts.
Hearing Care
Some Medicare Advantage plans offer hearing care benefits, including hearing exams and hearing aids. However, the specifics of the coverage can vary between plans, such as the frequency of exams covered or the amount of coverage for hearing aids.
It’s important to review the specifics of each plan to determine which one best meets your needs. If you’re looking for help finding the right Medicare Advantage plan for you, contact Eric Zawicki at HealthMarkets Insurance. We can help you compare plans and find the right Medicare coverage for your healthcare needs.
