Here’s the Rundown: If you get a Medicare Advantage plan, you may get extra Medicare Advantage benefits that are not usually provided by Original Medicare (Part A and Part B) – like prescription drug coverage or fitness benefits.
Keep in mind that not all Medicare Advantage benefits are covered in the same way by all plans.
Here are seven benefits to consider when shopping for Medicare Advantage plans.
1. Medicare Advantage prescription drug coverage
According to research for the Mayo Clinic, nearly 70 percent of Americans take at least one prescription drug and 20 percent take five or more prescription drugs.
Original Medicare generally doesn’t cover most prescription drugs you take at home.
However, one benefit that most Medicare Advantage plans include is coverage for prescription drugs you take as an inpatient, outpatient, and at home.
With these Medicare Advantage plans, there is no separate premium for prescription drug coverage since it’s a Medicare Advantage benefit that is covered.
You already pay for it in your monthly Medicare Advantage plan premium.
You may pay a separate prescription drug deductible, for example, $250 a year.
You also will generally pay something when you fill a prescription, for example, a $15 copayment for a generic medication and a $47 copayment for a preferred brand medication.
2. Medicare Advantage dental coverage
Original Medicare generally doesn’t cover dental care, except in certain extreme and emergency situations.
However, you may be able to find a plan that covers routine dental care as a Medicare Advantage benefit included in your plan.
Routine dental care includes things such as
A Medicare Advantage plan is the only way to get routine dental care through Medicare.
3. Medicare Advantage vision coverage
Unlike Original Medicare, many plans cover routine vision coverage as a Medicare Advantage benefit.
Routine vision care includes things such as
- Eye exams
- Eye glasses
Original Medicare only covers eye exams related to certain conditions such as diabetes, glaucoma, and macular degeneration.
4. Medicare Advantage hearing coverage
According to the National Institutes of health, hearing loss is one of the most common conditions affecting older adults.
Despite this, Original Medicare generally doesn’t cover routine hearing coverage.
However, a Medicare Advantage benefit you may get through your Medicare Advantage plan is coverage for routine hearing care.
You can expect the following to be covered if your chosen plan covers hearing care as a Medicare Advantage benefit:
- Routine hearing exams
- Fittings for hearing aids
- Hearing aids.
There may be a limit on how much the plan will pay for hearing aids.
For example, a $1,000 limit every three years for hearing aids for both ears combined.
5. Medicare Advantage fitness benefits
One Medicare Advantage benefit is a fitness program is called SilverSneakers.
SilverSneakers may provide you with unlimited access to gyms in your area, as well as fitness classes.
According to the U.S. National Library of Medicine, exercise for seniors can help you build strength, avoid falls, and keep your body limber.
6. Medicare Advantage out-of-pocket maximums
Original Medicare has no out-of-pocket maximum.
That means that if you get a complicated surgery, have a prolonged hospital stay, or need frequent outpatient procedures or doctor visits, you may have to pay tens of thousands of dollars out of your own pocket.
All Medicare Advantage plans, on the other hand, have an out-of- pocket maximum.
In 2020, the upper limit for the Medicare Advantage out-of-pocket maximum was $6,700 for covered medical services.
Many Medicare Advantage plans set lower out-of-pocket maximums, for example according to eHealth research the average was $5,164 in 2019.
An out of pocket maximum as a Medicare Advantage benefit can give you the security of knowing that no matter how much medical care you need, your personal financial resources will only be drained so much.
Certain things generally don’t count towards your out-of-pocket maximum, such as prescription drug copayments and out of network care.
7. Medicare Advantage copayments
The Medicare Advantage cost sharing structure is usually copayments rather than coinsurance.
A copayment is a set dollar amount, for example $10, that you pay to visit your primary care physician.
On the other hand, the cost sharing structure of Original Medicare is coinsurance, making you responsible for example of 20% of the Medicare approved amount for a service.
With a copayment, you know what you will pay when you receive a medical service.
With a coinsurance, you won’t know the dollar amount until you receive the bill.
The Medicare Advantage copayment structure is a Medicare Advantage benefit that may make it easier to budget your medical expenses.
Now that you know about these seven benefits of Medicare Advantage plans, it may be time to get started shopping for a Medicare Advantage plan.