Which type of care is not covered by Medicare? It’s a common question among older adults aged 65+. The fact is that original Medicare (Parts A and B) doesn’t cover everything—and it may not be comprehensive enough for your healthcare needs. If that’s the case, you may want to consider enrolling in a Medicare Advantage (MA) plan.
What is Medicare Advantage?
Medicare Advantage plans, also referred to as Part C plans are private health plans that have contracts with Medicare. If you decide to enroll in an Medicare Advantage plan, your Medicare-covered health care services go through the private plan. Medicare Part C plans typically require the use of in-network providers that have contracts with the Medicare Advantage plan, including doctors, hospitals, drug stores and other healthcare providers. The use of providers outside the plan’s network may incur additional costs or not be covered by Medicare.
What do Medicare Advantage plans cover?
Medicare Advantage plans include Medicare Part A (hospital services) and Part B (doctor’s visits). In addition, most Medicare Advantage plans offer coverage for services that Original Medicare doesn't cover, such as:
- Vision /eyeglasses
- Hearing / hearing aids
- Dental
- Health club memberships
- Medically necessary transportation
How much does Medicare Advantage cost?
Enrollment in Medicare Parts A and B is a requirement to join a Medicare Advantage plan. Monthly Part B premiums must be paid. The Part B premium usually comes out of your Social Security checks automatically, but you should confirm with plans directly before deciding to enroll.
You may also pay an additional monthly premium on top of the Part B premium and, for some services, a deductible and a portion of the cost of the services you receive. This additional premium helps pay for the extra benefits some Medicare Advantage plans offer their members. The structure of costs varies across different Medicare Advantage plans.
You may be able to get help paying out-of-pocket Medicare Advantage costs if you qualify for Medicaid or Medicare Savings Programs.
What are the different types of Medicare Advantage plans?
There are five different types of Medicare Advantage plans available:
- Health Maintenance Organizations (HMOs) - If care is not received from an HMO approved provider, called an in-network provider, Medicare will not cover it. A referral is typically needed from a primary care provider to see a specialist.
- Medical Savings Accounts (MSAs) - A high deductible must be paid before the plan covers any benefits. A health savings account is linked to the plan and Medicare puts money in the savings account each year. However, the amount is less than the annual deductible.
- Preferred Provider Organizations (PPOs) - You can receive care from a Medicare provider who is out-of-network, but the costs are higher. A primary care doctor is not needed.
- Private Fee-for-Service plans (PFFS) - There is no network of providers. Any Medicare provider who agrees to the plan’s terms and payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary.
- Special Needs Plans (SNPs) - These are PPOs or HMOs that only admit people with Medicare who have certain conditions. Learn more .
Enrolling in both Medicare Advantage and Medigap (supplemental insurance) is not allowed
If you’re enrolled in a Medicare Advantage plan, you cannot purchase a Medigap policy. Once enrolled in an MA plan, there are limited opportunities to switch to a Medigap policy plus Original Medicare in the future. It’s important to understand your choices before you enroll.
