What Do Medicare Advantage Plans Cover in 2023?

October 19, 2023

Over 28 million Medicare beneficiaries are enrolled in Medicare Advantage Plans in 2023. These popular private insurance plans provide all Original Medicare Part A and Part B benefits along with extra coverage. But what exactly do Medicare Advantage Plans cover? This comprehensive guide examines the medical services, prescription drugs, and additional benefits included in Medicare Advantage Plans this year.

Understanding Medicare Advantage

First, let’s provide some background on Medicare Advantage. Also known as Medicare Part C, Medicare Advantage Plans are offered by private insurers as an alternative way to receive your Medicare benefits. Some key facts:

Includes all benefits of Original Medicare Part A and Part B premium
Usually includes prescription drug coverage
Often covers additional services Original Medicare doesn’t cover
Insurers offer different plan options to choose from
Provider networks, costs and benefits vary by plan

When you join a Medicare Advantage Plan, you still have Medicare program but get your benefits through the private insurer. Medicare pays the plan to cover your care.

What Healthcare Services Do Medicare Advantage Plans Cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers, including:

Inpatient hospital care
Skilled nursing facility care
Home healthcare
Hospice care
Doctor visits
Preventive services
Outpatient care
Ambulance transportation
Durable medical equipment
Mental health services

In other words, you’ll have all the benefits of Medicare Part A and Part B. Medicare Advantage Plans are required to cover these services. Costs like deductibles, copays or coinsurance may apply depending on the plan.

Do Medicare Advantage Plans Cover Prescription Drugs?

A major benefit of most Medicare Advantage Plans is that they include prescription drug coverage.

With Original Medicare, you need to purchase a separate Part D prescription drug plan from an insurer. But with Medicare Advantage, drug coverage is usually bundled together with your medical benefits.

Medicare Advantage prescription drug coverage typically includes:

List of covered brand-name and generic medications
Network of preferred pharmacies
Copays or coinsurance for each drug tier
Initial coverage phase where you pay reduced costs
Coverage gap phase where you pay a higher percentage
Catastrophic coverage with low costs once you reach the out-of-pocket threshold

Make sure to review a plan’s formulary and pharmacy network before enrolling. The costs and covered medications can vary between Medicare Advantage Plans.

What Extra Benefits Can Medicare Advantage Plans Offer?

Medicare Advantage Plans often cover valuable benefits that Original Medicare does not, including:

Dental – Cleanings, X-rays, fillings, dentures
Vision – Routine eye exams, eyeglasses or contacts
Hearing – Hearing exams, hearing aids
Fitness – Gym membership, fitness trackers
OTC Items – Over-the-counter drugs, first aid supplies
Wellness – Nutritional counseling, health education
Transportation – To doctor appointments

These supplemental benefits are a major reason many choose Medicare Advantage Plans over Original Medicare. Keep in mind benefits can vary – not all plans offer every extra.

How Do I Know What a Plan Covers?

Each Medicare Advantage Plan can offer different amounts of coverage and benefits. To confirm exactly what a plan includes:

Review the plan’s Summary of Benefits. This outlines all included services, cost-sharing amounts, provider network, pharmacy benefits, and supplemental benefits.
Check the plan’s Evidence of Coverage (EOC). This is the legal document that provides the full details about the plan’s benefits, costs, rules and more.
Speak to a representative from the insurance company offering the plan to get answers to any questions.
Work with an independent broker who can explain plan details and make sure you understand covered services.

Doing your homework is crucial to avoid surprises after you enroll in a Medicare Advantage Plan. Comparing options will help you identify the optimal coverage.

Can Medicare Advantage Plans Change Coverage Yearly?

Yes, Medicare Advantage Plans can change cost-sharing amounts, covered services, provider networks, prescription drug formularies, and extra benefits from one year to the next.

Each fall is the Annual Election Period when insurers release details about the next year’s plans. You should always review your coverage during this period to make sure your plan still meets your needs.

You can switch Medicare Advantage Plans or return to Original Medicare and a Part D Plan if you find a better option. Under certain circumstances, you may also qualify for Special Election Periods during the year if you want to make a change.

Enrolling in Medicare Advantage

To join a Medicare Advantage Plan, you must be enrolled in Medicare Part A and Part B first. You can select a plan offered in your area by a private insurer when first eligible for Medicare, during the Annual Election Period, or if you qualify for a Special Election Period.

Be sure to choose a Medicare Advantage Plan that provides suitable coverage and costs for your healthcare needs. Working with an independent broker in your state simplifies the process of comparing your options and enrolling.

Key Takeaways

Medicare Advantage Plans cover all services Original Medicare does
They usually include prescription drug coverage with lower costs
Many plans offer extra benefits not covered by Original Medicare
Each plan can have different amounts of coverage and costs
You should review plans every year at Annual Election Period

Understanding what Medicare Advantage Plans cover provides insights that can help you make smart healthcare decisions. Doing your homework avoids surprises and ensures you select optimal Medicare coverage.

FAQS

What is a Medicare Advantage Plan?

A Medicare Advantage Plan is a type of Medicare health plan offered by private insurance companies that combines hospital, medical, and sometimes prescription drug coverage in one plan.

What does a Medicare Advantage Plan cover?

Medicare Advantage Plans must cover all services that Original Medicare covers, but they can also choose to cover additional services such as dental care, vision care, and hearing aids.

What is excluded from a Medicare Advantage Plan cover in 2023?

In 2023, Medicare Advantage Plans may exclude certain services or supplies from coverage. These exclusions can vary depending on the specific plan, but commonly excluded items and services may include dental services, cosmetic surgery, and over-the-counter medications.

What are supplemental benefits?

Supplemental benefits are additional benefits that a Medicare Advantage Plan may offer beyond what is covered by traditional Medicare, such as dental care, fitness programs, or transportation services.

What is cost sharing?

Cost sharing refers to the out-of-pocket costs that you may be required to pay when using services covered by a Medicare Advantage Plan. This can include copayments, coinsurance, and deductibles.

Can a Medicare Advantage Plan cover services or supplies that are not covered by Original Medicare?

Yes, Medicare Advantage Plans may cover services or supplies that are not covered by Original Medicare. However, the specific coverage can vary depending on the plan.

How can I find information about Medicare Advantage Plans for 2022?

You can find information about Medicare Advantage Plans for 2022 by contacting your plan directly or by visiting the official Medicare website.

Are dental care and dental services covered by Medicare Advantage Plans?

Medicare Advantage Plans may offer coverage for dental care and dental services, but the extent of coverage can vary depending on the plan.

Can a Medicare Advantage Plan also cover hospice services?

Yes, Medicare Advantage Plans may also cover hospice services if you meet the eligibility requirements for both Medicare and hospice care.

Do Medicare Advantage Plans require prior authorization for certain services?

Some Medicare Advantage Plans may require prior authorization for certain services, meaning you would need to obtain approval from the plan before receiving the service.