Medicare is the health insurance plan administered by the U.S. Government for anyone 65 or older who paid payroll taxes. It also covers some individuals who suffer from disabilities. However, Medicare does not treat every sort of health situation, as it is supposed to comprise only basic health coverage. Other care, such as vision, dental, and prescription drug coverage, are not part of Medicare. This is why some Medicare consumers choose to take part in a Medicare Advantage plan in addition to their basic Medicare coverage.
What’s a Medicare Advantage Plan?
Through Medicare Advantage, private companies work with Medicare to offer both Medicare Part A and B benefits as well as the supplementary health coverage that isn’t incorporated in primary Medicare plans.
What is in Medicare Part A and Part B?
Medicare Part A offers essential hospital coverage, which includes in-patient, hospice, and nursing care, among other services.
Providing more comprehensive coverage, Medicare Part B may offer some outpatient hospital care, preventative medical procedures, as well as general physician and surgical coverage. Both Medicare Part A and B are included in Medicare Advantage coverage.
What’s in Medicare Advantage coverage?
Medicare Advantage plans include a wider variety of care and services. All Medicare Advantage plans include Medicare Part A and B. However, some also include supplementary health care, such as a yearly physical, vision care, dental care, and pharmaceutical medications. The majority of Medicare Advantage plans provide prescription drug coverage, a notable reason why many consumers participate in these plans. If for some reason a Medicare Advantage plan doesn’t offer prescription drug coverage, Medicare Prescription Drug Plans are designed to cover this gap.
How Medicare Advantage works alongside Medicare to cover your health needs
Medicare pays a fixed amount every month to the private insurance company providing Medicare Advantage. Although these companies must adhere to Medicare regulations, they do have varying out-of-pocket expenses for each type of coverage. Basically, there are different regulations for how expenses and procedures for health care are determined—all depending on the Medicare Advantage plan you’ve chosen.
Medicare Advantage plan types
There are a wide variety of Medicare Advantage plans out there. The one you should choose depends on your individual situation. The most often chosen coverage includes these main types:
- HMO plans, where you are restricted to a healthcare provider on an HMO list.
- PPO plans, where you pay additional fees if you visit a health care provider that is not on a PPO list.
- Private Fee-for-Services plans, which manage how much you spend and how much the private company covers when you’re at the health care provider’s location.
- Special Needs Plans—only available to patients with specific diagnoses.
Qualifying for a Medicare Advantage Plan
It is relatively simple to join a Medicare Advantage program. Do you already have Medicare Part A and B? Do you live in the service area of the plan you hope to join? Do you not have End-Stage Renal Disease*? If the answer to all three is yes, you qualify for Medicare Advantage. (Don’t forget: if you don’t already have Medicare Part A and B, you won’t qualify for Medicare Advantage.)
Overall, Medicare Advantage plans provide additional coverage for services you may not be receiving through traditional Medicare. If you need these additional treatments or services, it’s well worth checking out this supplementary
*If you were already covered by a Medicare Advantage plan when diagnosed with End-Stage Renal Disease, or have had a successful kidney transplant, you may be able to stay with your Medicare Advantage coverage.