What Medicare Advantage Covers That Original Medicare Doesnt

Exploring the differences between Medicare Advantage and Original Medicare, this article delves into the specific services and benefits covered by Medicare Advantage but not by Original Medicare. From prescription drug coverage to specialized care, we uncover the unique offerings of Medicare Advantage plans.

What Medicare Advantage Covers That Original Medicare Doesn’t

Medicare Advantage plans offer coverage for services and benefits that are not included in Original Medicare. These plans often provide additional options to enhance healthcare coverage for beneficiaries.

Prescription Drug Coverage

One of the key benefits of Medicare Advantage plans is the inclusion of prescription drug coverage, known as Medicare Part D. This coverage helps individuals afford necessary medications that may not be covered under Original Medicare.

Vision, Dental, and Fitness Programs

Unlike Original Medicare, Medicare Advantage plans may offer benefits such as vision and dental coverage, as well as fitness programs. These additional services can help improve overall health and well-being for plan members.

Telehealth, Wellness Programs, and Caregiver Support

Medicare Advantage plans often provide coverage for telehealth services, wellness programs, and caregiver support. These services help individuals access healthcare remotely, maintain a healthy lifestyle, and receive assistance from caregivers when needed.

Cost Differences Between Medicare Advantage and Original Medicare

Medicare Advantage plans and Original Medicare have different cost structures that beneficiaries should consider when choosing their coverage. Here is a comparison of the out-of-pocket costs associated with each option:

Lower Copayments or Coinsurance with Medicare Advantage

Medicare Advantage plans often offer lower copayments or coinsurance for certain services compared to Original Medicare. For example, a Medicare Advantage plan may have a $0 copayment for primary care visits, while Original Medicare typically requires a 20% coinsurance payment.

All-In-One Coverage with Medicare Advantage

Original Medicare requires beneficiaries to purchase supplemental insurance, such as a Medigap policy, to cover gaps in coverage. In contrast, Medicare Advantage plans may offer all-in-one coverage that includes benefits beyond what Original Medicare provides. This can result in potentially lower overall costs for beneficiaries, as they do not have to purchase additional insurance to fill coverage gaps.

Provider Networks and Referral Requirements

When comparing Medicare Advantage plans to Original Medicare, one crucial aspect to consider is the differences in provider networks and referral requirements. Understanding these differences can help beneficiaries make informed decisions about their healthcare options.Provider networks in Medicare Advantage plans are often structured around preferred provider organizations (PPOs) or health maintenance organizations (HMOs).

These networks dictate which doctors, specialists, hospitals, and other healthcare providers are covered under the plan. In contrast, Original Medicare allows beneficiaries to see any healthcare provider that accepts Medicare.

Provider Networks in Medicare Advantage Plans

• Preferred Provider Organizations (PPOs) in Medicare Advantage plans offer more flexibility in choosing healthcare providers. Beneficiaries can typically see out-of-network providers, albeit at a higher cost.
• Health Maintenance Organizations (HMOs) in Medicare Advantage plans require beneficiaries to choose a primary care physician and obtain referrals to see specialists. This managed care approach aims to control costs and coordinate care effectively.

Importance of Checking Provider Networks

It is essential for beneficiaries to check the provider networks of Medicare Advantage plans before enrolling. Ensuring that preferred doctors, specialists, and hospitals are included in the network can lead to better access to care and potentially lower out-of-pocket costs.

Failure to verify network coverage may result in unexpected expenses or limited choices in healthcare providers.

Coverage for Medical Services and Specialized Care

Medicare Advantage plans often offer coverage for a variety of medical services and specialized care that Original Medicare does not cover. This can provide beneficiaries with access to a broader range of healthcare options tailored to their specific needs.

Coverage for Medical Services

• Many Medicare Advantage plans include coverage for services like hearing aids, chiropractic care, and acupuncture. These alternative treatments can be beneficial for individuals seeking non-traditional medical interventions.
• Some plans may also offer coverage for preventive services like gym memberships or nutrition counseling, promoting overall health and wellness.

Specialized Care Coverage

• Medicare Advantage plans may cover specialized care such as vision correction surgery, which can be a life-changing procedure for individuals with vision impairment.
• In-home caregiver services are another example of specialized care that some Medicare Advantage plans cover, providing essential support for those in need of assistance with daily activities.

Examples of Coverage Differences

• For instance, if a beneficiary requires chiropractic care for a chronic condition, a Medicare Advantage plan may cover these visits, whereas Original Medicare does not typically cover these services.
• Similarly, if an individual needs acupuncture treatments for pain management, a Medicare Advantage plan may offer coverage for these services, providing more comprehensive care options.

Epilogue

In conclusion, the realm of Medicare Advantage unveils a plethora of coverage options that go beyond what Original Medicare provides. From cost disparities to provider networks, the landscape of healthcare choices widens with Medicare Advantage.

FAQ Explained

What are some services covered by Medicare Advantage but not Original Medicare?

Medicare Advantage plans often include benefits like vision, dental, and fitness programs which are not covered by Original Medicare.

Do Medicare Advantage plans have lower out-of-pocket costs compared to Original Medicare?

Yes, Medicare Advantage plans may offer lower copayments or coinsurance for certain services, unlike Original Medicare.

Are there referral requirements for Medicare Advantage plans?

Medicare Advantage plans may have referral requirements based on their provider networks, unlike Original Medicare which does not have such requirements.