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What Does Medicare Advantage Plan Cover That Original Medicare Does Not?

When evaluating your Medicare coverage options, you may wonder – what does Medicare Advantage cover that Original Medicare does not? Understanding the differences in coverage can help you choose the right Medicare Plan.

Original Medicare Overview

With original or traditional Medicare, you get coverage under Part A and Part B. Medicare Part A covers hospital/inpatient care. Medicare Part B covers doctor visits, preventive services, durable medical equipment and other outpatient care.

However, Original Medicare does not cover all health services. For example, it does not include prescription drug coverage or routine dental, vision, or hearing care. There are gaps that you may want to fill through supplemental coverage.

Medicare Advantage Plan Coverage

Medicare Advantage Plans are offered by private insurers approved by Medicare. They provide all of your Part A and Part B coverage but often with lower out-of-pocket costs and extra benefits.

Some key advantages of Medicare Advantage Plans include:

  • Prescription drug coverage
  • Dental, vision, and hearing benefits
  • Health and wellness programs
  • Maximum annual out-of-pocket limits

So Medicare Advantage provides more comprehensive coverage all under one plan in many cases.

Difference between Original Medicare and Medicare Advantage

While Original Medicare and Medicare Advantage Plans must cover the same Part A and Part B services, there are some clear coverage differences:

Original Medicare

  • Covers hospital, medical, preventive services
  • Large out-of-pocket costs – 20% coinsurance
  • No drug, dental, vision, or hearing benefits

Medicare Advantage

  • Same coverage as Original Medicare
  • Lower out-of-pocket costs – copays
  • Often covers prescriptions, dental, vision, hearing
  • Plans have max annual out-of-pocket limits

Part C and Medicare Advantage Coverage

Medicare Part C refers to the sections of Medicare law that create Medicare Advantage Plans. It allows private insurers to offer Medicare benefits, often with expanded coverage.

Plans that are Part C plans include options like HMOs, PPOs, and Private Fee-for-Service plans from Medicare-contracted insurers. So all Medicare Advantage Plans fall under the Part C umbrella.

Part C gives Medicare enrollees more coverage choices beyond just Original Medicare.

Monthly Premium Differences

With Original Medicare, you must continue paying your Part B premium each month. For 2023, the standard Part B premium amount is $164.90 for most enrollees.

Many Medicare Advantage Plans have $0 monthly premiums beyond the Part B premium. Some may charge a small additional monthly premium for coverage. This provides premium savings compared to Medigap or other supplemental policies.

Out-of-Pocket Cost Differences

Original Medicare does not limit what you pay out-of-pocket each year. You are responsible for 20% coinsurance for Part B services after meeting the $226 Part B deductible. Costs can add up.

Most Medicare Advantage Plans have annual out-of-pocket maximum limits ranging from $3,000 to $8,300 depending on the plan. This protects you from extremely high medical costs.

Health and Wellness Offerings

Original Medicare covers medically necessary healthcare services but does not offer many preventive wellness benefits.

Many Medicare Advantage Plans include health and wellness programs like gym memberships, weight loss programs, home safety evaluations, and other services aimed at keeping you healthy.

Freedom of Choice Limitations

With Original Medicare, you can see any doctor or hospital nationwide that accepts Medicare. You are not restricted by provider networks.

Medicare Advantage Plans have provider networks you generally must use, except in emergencies. Not all doctors or hospitals may participate in Advantage Plans.

So when considering Medicare Advantage coverage, check that your preferred providers are in-network. Otherwise, you may incur larger out-of-pocket costs to see out-of-network providers.

Travel Coverage Differences

One advantage of Original Medicare is that your coverage works when traveling anywhere in the United States. As long as the provider accepts Medicare, your benefits are the same.

Medicare Advantage Plans often limit routine coverage when traveling outside your plan’s service area. They generally cover emergency and urgent care nationwide but other services may not be covered outside your area.

So with lots of travel, Original Medicare provides broader geographic coverage to consider.

Enrolling in Supplemental Coverage

While Medicare Advantage Plans bundle in coverage beyond Original Medicare, you can also enroll in supplemental policies:

  • Medigap – Helps pay Medicare out-of-pocket costs
  • Part D Plan – Covers prescription medications
  • Dental/vision/hearing plans – Provides routine dental, vision, hearing care

Purchasing additional plans allows customization and flexibility. Medicare Advantage delivers convenience of having expanded coverage in one plan.

Weighing Your Medicare Options

Look at premium costs, provider choices, prescription needs, and other personal factors when deciding between Medicare Advantage and Original Medicare. Medicare Advantage offers more covered services, but Original Medicare allows freedom and customization. Consider tradeoffs to select the right Medicare approach.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give Scott Sims at Sims Insurance Medicare Plans a Call at (541) 915-0939. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQs

What Does Medicare Advantage Plan Cover That Original Medicare Does Not?

Medicare Advantage Plans may offer additional benefits that Original Medicare does not cover. These benefits can include prescription drug coverage, dental services, vision services, hearing aids, and fitness programs.

Can I have a Medicare Advantage Plan and a Medicare drug plan at the same time?

No, you cannot have both a Medicare Advantage Plan and a separate Medicare drug plan at the same time. Most Medicare Advantage Plans include prescription drug coverage, so you should not enroll in a separate Medicare drug plan unless your Medicare Advantage Plan does not offer drug coverage.

Do I still need to pay a premium for Medicare Part B if I have a Medicare Advantage Plan?

Yes, you still need to pay the monthly Part B premium if you have a Medicare Advantage Plan. In addition to the premium for your Medicare Advantage Plan, you will need to continue paying the standard monthly Part B premium to maintain your Medicare coverage.

Can I compare Original Medicare and Medicare Advantage Plans?

Yes, you can compare Original Medicare and Medicare Advantage Plans to understand the different coverage options available to you. You can visit the official Medicare website or consult with a licensed insurance agent to compare the benefits and costs of different plans.

Can I join a separate Medicare drug plan if I have a Medicare Advantage Plan?

No, if you have a Medicare Advantage Plan that includes prescription drug coverage, you cannot join a separate Medicare drug plan. You will receive all of your prescription drug coverage through your Medicare Advantage Plan.

Are there any benefits that Original Medicare provides that Medicare Advantage Plans do not?

Original Medicare provides coverage for certain services that Medicare Advantage Plans may not cover, such as hospice care. Additionally, with Original Medicare, you can use any doctor or hospital that accepts Medicare patients, whereas Medicare Advantage Plans often have a network of preferred providers.

Can I join a Medicare Advantage Plan if I already have a Medicare Supplement insurance (Medigap) plan?

No, you cannot have both a Medicare Advantage Plan and a Medicare Supplement insurance plan at the same time. You must choose between the two options, as they provide different types of coverage.

Do Medicare Advantage Plans have a yearly limit on out-of-pocket costs?

Yes, Medicare Advantage Plans have a yearly limit on out-of-pocket costs. Once you reach this limit, your plan will cover 100% of the Medicare-approved services for the rest of the year.

Can Medicare Advantage Plans offer additional benefits not covered by Original Medicare?

Yes, Medicare Advantage Plans may offer additional benefits that are not covered by Original Medicare. These benefits can include routine vision and dental care, prescription drug coverage, and wellness programs.

Do I need to pay a separate premium for my Medicare Advantage Plan?

Yes, you will need to pay a separate premium for your Medicare Advantage Plan in addition to your monthly Part B premium. The amount of the premium may vary depending on the plan you choose.