Medicare Advantage (also known as Medicare Part C) is a private alternative to Original Medicare (Parts A & B) and typically offers additional benefits, such as prescription drug coverage, dental, vision, and hearing services.
Medicare Advantage plans often limit your coverage to a particular network of healthcare providers, which allows insurance carriers to charge lower premium.
What does Medicare Advantage cover?
These plans can also offer additional benefits that you can’t get under Original Medicare.
In addition to the most common extras—prescription drug, vision, dental, and hearing care coverage—some plans offer various types of wellness benefits such as discounted gym memberships and weight loss counseling.
Starting in 2019, some plans may offer transportation services to and from doctors, access to telemedicine, coverage to install bathroom safety devices, and other newly available benefits.
Even if you have Medicare Advantage, Original Medicare will still be the go-to insurer for coverage of hospice care and some costs for clinical research studies, if you need these services.
It’s important to remember that Medicare Advantage’s extra benefits typically come with different rules and restrictions: In most cases, you have to visit a healthcare provider who is in your plan’s designated network or, if this option is offered, face higher costs to see an out-of-network provider. You also commonly need a referral to see a specialist.
What is the premium for a Medicare Advantage plan?
Medicare Advantage plans are sold by private insurance companies, and their coverage, premiums, and out-of-pocket costs vary widely depending on the carrier and plan features.
It is possible to find a Medicare Advantage plan that does not charge an additional monthly premium beyond your Part B premium. You must continue to pay your Part B premium directly to Medicare, even if you are on a Medicare Advantage plan.
Medicare Advantage plans must offer at least the same benefits as Original Medicare, and most also offer prescription drug coverage. In some cases there may be an additional premium for benefits that aren’t offered by Original Medicare, such as routine vision, hearing, and dental coverage.
In addition to any monthly premiums, you may have to meet a deductible and pay copayments or coinsurance for doctor visits and other medical services.
Check your plan’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) for specific information about costs.
Do Medicare Advantage plans have deductibles?
The deductibles in individual Advantage plans typically range from $0 to $200, depending on the insurer and the benefits offered, but can go as high as $1,000 or more for medical services that would be covered under Part A & B.
By contrast, under Original Medicare in 2019, Medicare Part A (hospital insurance) has a deductible of $1,364 per benefit period. Meanwhile, Medicare Part B (medical insurance) has an annual deductible of $185.
These costs can change each year, and your plan will notify you of any changes in your ANOC.
Will I pay coinsurance with Medicare Advantage?
Cost vary widely among Medicare Advantage (Part C) plans, and you may need to pay coinsurance, depending on which plan you choose. Even if basic medical and hospital care is 100% covered, you may have to pay coinsurance for other specific services such as outpatient surgery, durable medical equipment, cancer treatments, and prescription drugs.
Are there copayments with Medicare Advantage?
You may have copayments, depending on which Medicare Advantage (Part C) plan you choose. Each plan typically has different policies on out-of-pocket costs, including whether or not you’ll pay a flat-dollar copayment for doctor visits.
These costs can change each year. Your plan is required to notify you of any changes in the Annual Notice of Change (ANOC). These documents are typically mailed to you, but they can be emailed as well, depending on the insurer and your delivery preferences.
Does Medicare Advantage cover dental?
Unlike Original Medicare (Parts A & B), many Medicare Advantage (Part C) plans offer some degree of dental care.
The degree of coverage, though, differs widely among Advantage plans. Among those that have dental benefits, the most commonly offered are coverage of cleanings, X-rays, and annual exams. Many also include some coverage of fillings, extractions, root canal, dentures, crowns and bridges, and gum disease treatment.
To see if your plan covers dental services and, if so, which ones, read the Evidence of Coverage (EOC) document you received, or contact your insurer.
Does Medicare Advantage cover hospice care?
You can get hospice care if you have Medicare Advantage (Part C), but it will be covered under Part A of Original Medicare.
To be eligible for hospice care under Medicare:
- Your hospice doctor and your regular doctor must certify that you’re terminally ill (expected to live six months or less).
- You opt for palliative care (for comfort) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
- Learn more about hospice and Medicare here.