Medicare Advantage plans allow Medicare beneficiaries to use their government benefits toward purchasing private health insurance coverage. Medicare Advantage plans may cost more but often come with additional perks, such as lifestyle benefits and coverage for nonprescription products.
It is important for people to consider various factors when choosing a Medicare Advantage plan. These can include monthly premiums, the network of healthcare providers, and other benefits such as dental and vision coverage.
This article briefly outlines Medicare Advantage and offers tips on how people can pick a suitable plan for their needs.
Medicare Advantage plans combine government-administered Medicare parts A and B, also called Original Medicare.
Medicare Advantage or Medicare part C plans are private insurance plans that offer the same benefits as Original Medicare, often along with additional benefits.
How to enroll in Medicare Advantage
Before purchasing a Medicare Advantage plan, a person must enroll in Medicare parts A and B. The private insurance company will need the person’s Medicare number to enroll them.
People can visit Medicare.gov or speak directly with an insurance broker to enroll in a plan.
When choosing a Medicare Advantage plan, it is important for people to consider their healthcare needs and budget. Medicare Advantage plans and benefits vary, so reviewing plan details or asking an insurance broker for help is crucial when choosing between plans.
Here are some factors to keep in mind.
This is the amount a person pays each month for insurance coverage. Typically, the lower the premium, the higher the out-of-pocket costs will be when a person uses medical services.
Copay or coinsurance
This is the amount a person pays when they collect a prescription or receive healthcare services. Depending on the Medicare Advantage plan, a person may pay a fixed dollar amount, known as copay, or a percentage of the cost of care called coinsurance.
Private insurance companies have their own networks of healthcare providers that they consider to be in-network. In-network doctors, dentists, therapists, and health systems provide services for members of the health insurance plan at an agreed-upon rate. People will pay less when they use healthcare providers in their network.
People should pay attention to the network when choosing a plan.
Some networks are small and only include healthcare providers within a particular hospital system or a specific regional area. A plan with a small network might be less expensive than one with a broad, nationwide network. However, someone who plans to travel frequently might decide to go with the broader network.
Original Medicare does not offer lifestyle or wellness benefits.
However, many Medicare Advantage plans may include access to exercise programs, gym memberships, and fitness equipment. Some plans may also offer access to wellness programs like nutrition coaching and safe driving classes.
Other potential lifestyle benefits may include:
- access to online exercise programs
- discounts on health-related products like healthy meal delivery
- access to healthy living classes and webinars
- transportation to medical appointments
Not all plans have extensive lifestyle benefits, and these will vary from plan to plan. People should review any additional lifestyle benefits to determine which ones may work best for their needs.
Questions to ask when choosing a plan
- Can I keep my current doctor with this plan?
- Are my prescription drugs covered on the formulary?
- Does this plan offer benefits adequate for any health conditions I am managing?
- Does this plan offer extras such as hearing aid coverage or fitness benefits?
Aside from considering a plan’s cost, network, and lifestyle benefits, other potential Medicare Advantage plan benefits include:
Original Medicare does not cover most dental care.
However, some Medicare Advantage plans might include dental coverage. People should check plan details to confirm.
Original Medicare covers vision care only if it is part of medical care for a condition such as diabetes.
However, some Medicare Advantage plans may cover routine eye exams and corrective lenses.
Original Medicare does not cover hearing tests or hearing aids. If a person requires hearing services for a medical issue, coverage may be available under Original Medicare.
Some Medicare Advantage plans offer benefits for hearing aids and services.
In-home care services
Original Medicare may cover some health services such as part-time nursing care, occupational therapy, social services, and medical equipment. However, Medicare will only cover home healthcare if a doctor orders it as medically necessary.
Some Advantage plans offer expanded in-home care services.
Prescription drug coverage
Original Medicare does not cover prescription drugs unless a doctor administers them in a healthcare setting such as a hospital.
To receive drug coverage, people must purchase a Medicare Part D plan, which some Medicare Advantage plans include.
Over-the-counter (OTC) product discounts
Generally, Original Medicare does not cover items people can purchase in stores, with the exception of COVID-19 tests.
Some Medicare Advantage plans come with coverage for OTC items such as aspirin, vitamins, and sunscreen.
Mental health support
Medicare Part B helps pay for outpatient mental healthcare, including screenings, counseling, and injected medications that a person cannot take on their own.
Part A covers inpatient care for admission to a hospital or care facility for a mental health condition.
Medicare Advantage plans have the same or better mental health coverage. However, people taking medication should consider a plan with drug coverage.
Medicare Part B offers coverage for telehealth services, including phone or video chat sessions with a healthcare professional.
Medicare Advantage plans may offer customers additional coverage for telehealth services.
Medicare Advantage plans offer at least the same coverage as Original Medicare but often come with additional benefits. When comparing Medicare Advantage plans, people may want to consider lifestyle benefits like fitness programs, coverage for OTC medications, and transportation to medical appointments.
Choosing a plan with additional benefits that meet their specific needs can help people get the most out of their Medicare Advantage coverage.