What Do Medicare Advantage Plans Cover?

What sets Medicare Advantage apart is the additional benefits, including drug, dental, and vision services and membership in wellness and health management programs.

As an alternative to Original Medicare, Medicare Advantage plans must cover all Part A and B services. This means the plan aids in paying for hospital stays and most medical services (excluding hospice care). What sets Medicare Advantage apart is the additional benefits, which can include dental and vision services as well as membership in wellness and health management programs.

Many Medicare Advantage plans also include qualified prescription drug coverage, so you don’t need to purchase a stand-alone Part D drug plan. These plans are marketed as Medicare Advantage Prescription Drug, or MAPD, plans.

What Do These Plans Cost?

Since you’re still enrolled in Medicare, you will still pay any required monthly premiums for Parts A and B. Beyond this, a Medicare Advantage plan’s cost depends on several factors. These factors can be:

• Monthly premiums included in the plan
• Yearly deductibles
• Copayments or coinsurances included in the plan

A brief outline of Medicare Advantage plan costs is available on Medicare.gov.

What Do I Need to Do to Get a Plan?

To join a Medicare Advantage plan, you must tick a few boxes. First, you must be enrolled in Original Medicare. Next, you must live within that plan’s service area.

Finally, you cannot have End-Stage Renal Disease (ESRD). This is the only pre-existing condition that can disqualify you from Part C coverage. For those with ESRD, Original Medicare covers the treatment.

Is There Anything Else We Should Know?

• Each year, you have two opportunities to make changes to your Medicare Advantage plan. The primary season is the Annual Enrollment Period, which runs from October 15 to December 7. During this period, you can:
• Switch from Original Medicare to a Medicare Advantage plan
  
  OR
• Switch from a Medicare Advantage plan to Original Medicare
  
  OR
• Switch from one Medicare Advantage plan to another

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31, allowing plan holders to make a one-time switch to a different Medicare Advantage plan or return to Original Medicare.

The second time to make a change in your coverage is during the Medicare Advantage Open Enrollment Period. This window runs from January 1 to March 31 and allows Medicare Advantage plan holders to make a one-time switch to a different Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you can purchase a Medicare Supplement and stand-alone prescription drug plan.

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If a Medicare Advantage or Medicare Supplement plan are coverage options that interest you, check out the Medicareful Plan Finder.

Further Reading

Medicare.gov — 13 things to know about Medicare Advantage Plans
Medicare.gov — Medicare Advantage Plans

Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.