What’s Covered in Medicare Advantage Plans?

Lucy Lazarony
November 3, 2020

Medicare Advantage plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide Medicare Part A and Medicare Part B benefits and services in a combined package also known as Medicare Part C. Most Medicare Advantage plans also offer prescription drugs coverage and additional benefits such as vision, hearing and dental bundled together. Let’s take a closer look at Medicare Advantage plans and how they compare to Original Medicare.

Medicare Part A and Medicare Part B

Medicare Advantage plans cover all the benefits and services of Medicare Part A and Medicare Part B. Here’s a look at those benefits. Medicare Part A covers inpatient care at home, in a hospital, skilled nursing facility, nursing home and hospice.

Medicare Part B covers doctor visits and any services or supplies that are needed to diagnose or treat a patient’s medical condition and that meet accepted standards of medical practice. In addition, Medicare Part B covers health care to prevent illnesses, such as the flu or to detect illnesses at an early stage when treatment is most likely to work the best.

Medicare Part B also covers things such as clinical research, ambulance services, durable medical equipment, mental health services including in-patient, out-patient and partial hospitalization and limited out-patient prescription drugs.

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Medicare Home Health Benefits

Medicare Advantage plans must provide all enrollees with all the coverage included in Medicare Part A and Medicare Part B, including the home health benefit. The Medicare home health benefit provides coverage for home visits by skilled health professionals. Home health benefits consist of part-time, medically necessary skilled care that is ordered by a physician. This skilled care includes nursing, physical therapy, occupational therapy and speech and language therapy. Medicare home health benefits are available in a patient’s home or assisted living facility.

With Medicare home health benefits, a physician signs a plan of care including a home health certification. And the patient must receive aid from a Medicare-certified home health agency. So if you are searching for home health services to be paid for by Medicare make sure the agency is Medicare-certified otherwise the benefit won’t be covered.

Who qualifies for a Medicare home health benefit? Individuals that have a condition due to illness or injury that restricts the ability of the individual to leave his or her home except with the assistance of another individual or aid of crutches, a cane, a wheelchair or a walker qualify for a home health benefit. The skilled nursing assistance through Medicare’s home health program can be as often as every day. And the Medicare home health coverage is available for necessary home care even if that care will extend over a long period of time. So every day care over a long period of time is available.

Medicare Advantage Plans Additional Benefits

Most Medicare Advantage plans offer coverage for things that aren’t covered by Medicare Part A and Medicare Part B. These benefits and services include vision, hearing, dental and wellness programs such as gym memberships. Other benefits include transportation to doctor visits, over-the-counter drugs and adult day-care services. In all types of Medicare Advantage plans, patients are always covered for emergency care and urgently needed care.

Medicare Advantage Plan Star Rankings

Having trouble choosing a Medicare Advantage Plan? Use the five-star ranking system as a guide. Medicare uses information from member satisfaction surveys and healthcare providers to give overall performance star ratings to plans. A plan can get between one and five stars. A five-star plan is best and indicates an excellent rating.

Weigh the pros and cons of each Medicare Advantage plan carefully. Study the costs and services provided and look at the star quality rating. Choose the plan that best fits your current and future medical needs.

Not sure of your medical needs? Make a list of the benefits and services that are important to you. Do you have a physician that you see on a regular basis? Are you taking prescription drugs? Do you see a specialist? Have you needed X-rays, MRIs or other diagnostic tests? When were you last in the hospital? Choose a Medicare Advantage plan that fits these needs.

Are all of these items covered? Is the physician you like so much covered with the plan? Where is the plan’s hospital? Is it nearby? Will it be easy for you to get there if you should need it? You want the best doctor choice and best hospital choice for your care. Next, check the plan’s Medicare star rating. Is it a five star rating? A three or a four? Choose the Medicare Advantage plan that meets your medical needs with a good star rating and with a price that you can afford.

If your medical needs change over the next year, it is okay. You can sign up for a new Medicare Advantage plan next year. Just make note of your changing medical needs so you can find the best Medicare Advantage plan for you when you sign up for a new plan next year.

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