What Does Medicare Advantage Cover? – Frequently Asked Questions
This article was updated on: 10/29/2018
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage (also called Medicare Part C) is an alternative way to get Medicare Part A and Part B benefits through a private Medicare-approved insurance company. Medicare Advantage combines all your Medicare benefits into one convenient plan except for hospice care, which is still covered by Part A. You’re still enrolled in Medicare when you have a Medicare Advantage plan and you still have Medicare rights and protections. According to the Kaiser Family Foundation, about 1 in 3 Medicare beneficiaries are enrolled in a Medicare Advantage plan.
What are the basic benefits that Medicare Advantage covers?
Medicare Advantage plans must cover at a minimum, all the services that Original Medicare covers. This includes:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Home health services
- Ambulance services
- Durable medical equipment
- Mental health services (inpatient and outpatient )
- Certain vaccines
What are extra benefits that Medicare Advantage covers?
- Prescription drugs: While Original Medicare does not cover most prescription drugs, most Medicare Advantage plans do cover prescription drugs.
- Over the counter medications: Some Medicare Advantage plans include a supplemental benefit for over-the-counter medications
- Dental care: Original Medicare generally does not cover routine dental care. However, Medicare Advantage may cover routine dental services, diagnostic services such as X-rays, and oral surgery.
- Vision care: Original Medicare generally does not cover routine vision care. Medicare Advantage may cover routine eye exams and eye wear such as contact lenses, eye glasses, lenses and frames.
- Hearing care: Original Medicare generally does not cover routine hearing care. Medicare Advantage may cover routine hearing exams and fittings for hearing aids.
- Additional inpatient days: Medicare Advantage may cover additional days in acute hospital care and skilled nursing facility care
What are other benefits of a Medicare Advantage plan?
- Some Medicare Advantage plans may offer a $0 monthly premium. However, you still have to pay your Part B premium.
- Unlike Original Medicare, Medicare Advantage plans have maximum out-of-pocket limits. That means there is a ceiling on how much you will pay each year before the plan covers all your health care costs.
Do you want more information about Medicare Advantage plans?
I can help you understand your options and get enrolled. I’m happy to set aside time for a phone discussion or send you an email containing plans that could work for you; the links for those are below, too. To start comparing Medicare Advantage plans now, click the Compare Plans buttons on this page.
Medicare has neither reviewed nor endorsed this information.