Making the Most of Your Medicare Advantage Plan
Medicare Advantage plans offer the same hospitalization and medical coverage as Original Medicare (Part A and Part B), plus additional benefits. Enrollees in Medicare Advantage enjoy add-ons such as dental, vision, and hearing services. Many Medicare Advantage plans also offer perks such as gym memberships and allowances for qualifying over-the-counter items.
Most Medicare Advantage plans also cover prescription drug (Part D) benefits and telehealth services, though cost and availability vary depending on where you live. Beneficiaries enjoy expanded preventive medical coverage designed to optimize their overall health and wellness options.
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1. Stay Informed About Plan Changes
Medicare Advantage plans offer supplemental benefits beyond Original Medicare, but they also operate somewhat independently through private insurance carriers. Each insurer offers distinct benefits and can set its own premium rates. You should check for updates periodically to ensure you get the most out of your coverage.
Some changes to your Medicare Advantage plan can occur at any time throughout the year. For example, your plan might drop your provider from their network in between open enrollment periods; however, you would only be eligible to switch plans during the next enrollment season. Additionally, Medicare Advantage plans set an annual out-of-pocket cap, which changes in amount every year.
2. Utilize Preventive Care Benefits
The importance of preventive care cannot be overstated, especially for seniors and other Medicare enrollees. While Medicare Part B covers some basic preventive care services, Medicare Advantage plans can offer expanded benefits, including annual wellness exams, health screenings, and vaccines.
Medicare Advantage provides access to screenings and tests for conditions commonly affecting seniors and high-risk individuals, including certain types of cancer, osteoporosis, and glaucoma. You should verify these services with your specific provider since preventive care benefits may vary by carrier.
3. Take Advantage of Extra Health Coverage
Medicare Advantage plans usually offer supplemental health benefits beyond those offered through Medicare Parts A and B. The following are the most popular “extra” benefits:
- Dental: Coverage typically includes routine oral exams, X-rays, and cleanings at no cost, with beneficiaries paying approximately 50% coinsurance for extensive dental services.
- Vision: Medical Advantage plans usually cover vision care for individuals with or at high risk for conditions such as cataracts, glaucoma, or macular degeneration. You can also get routine eye exams, contact lenses, and glasses through Medicare Advantage.
- Hearing: Medical Advantage offers access to a national network of audiologists and hearing professionals, $0 hearing exams, and low-cost copays or coinsurance for hearing aids.
- Health and Wellness: Additional perks of many Medicare Advantage plans include non-medical health and wellness services such as gym memberships, meal delivery, and allowances for over-the-counter medications.
4. Use Your Prescription Drug Coverage
Beneficiaries of Original Medicare must purchase a separate Part D plan for prescription drug coverage, whereas most Medicare Advantage plans include prescription drug benefits. Medicare Prescription Drug (MAPD) plans are required by law to cover a broad range of drugs and drug classes commonly taken by seniors and Medicare beneficiaries.
MAPDs typically offer a formulary of covered prescription medications. Most formularies cover generic versions of commonly prescribed medications to offset your out-of-pocket costs. Your Medicare Advantage plan may also require you to use an in-network pharmacy to fill your prescriptions in order to receive benefits.
5. Utilize Telehealth Services
Medicare Advantage plans often include expanded telehealth coverage compared to Original Medicare. Telehealth services may include the following:
- Psychotherapy
- Monthly end-stage renal disease checkups for patients undergoing dialysis at home
- Acute stroke diagnosis and treatment
Medicare Advantage beneficiaries can currently access telehealth services from any medical facility in an urban or rural area or their home.
6. Enjoy Your Unique Non-Medical Benefits
Medicare Advantage plans often come with the following non-medical benefits, which are especially beneficial for individuals seeking a healthy lifestyle and wellness routine.
- Nutritional Counseling: This includes medically necessary dietician services for individuals with kidney disease, diabetes, or a kidney transplant, and may also cover obesity screenings, weight-loss counseling, and diabetes-specific counseling.
- Meal Delivery Service: This is especially convenient for seniors and individuals with disabilities who struggle to cook every meal.
- Transportation: This benefit may include non-emergency medical and errand-related transportation like grocery shopping.
- Gym Membership: Gym memberships encourage fitness and physical activity for beneficiaries, keeping them healthy as they age.
- Over-the-Counter Allowances: Approved items may include over-the-counter drugs and vitamins, personal hygiene items, and first-aid products.
Putting It Together
Medicare Advantage offers supplemental medical care, including dental, vision, and hearing benefits, and health and wellness services. MAPD plans also provide prescription drug benefits. Individuals with Medicare Advantage can also enjoy perks such as telehealth services, healthy living incentives, and allowances for over-the-counter products.
Upon purchasing a Medicare Advantage plan from a private insurer, you should carefully review your explanation of benefits to confirm you can get the extended coverage you need. Frequently check with your insurer or Medicare.gov for updates, especially regarding your provider network and out-of-pocket maximums, which change each year.