What do Medicare Advantage (Part C) Plans Cover?

Medicare Advantage plans, also known as Part C plans, are offered by private health insurance companies that are approved by Medicare. Some Medicare Advantage plans even include prescription drug coverage (Part D).

We know that’s a lot of letters and parts to understand. See our blog that easily explains the ABC&Ds of Medicare to get a better understanding of what they all mean.

 

What do Medicare Advantage (Part C) Plans Cover?

The short answer is it depends on the plan. Each Medicare Advantage plan must include all the benefits offered with Original Medicare, but they are allowed to include extra benefits not available with Original Medicare. Those benefits can include anything from vision, dental, hearing, over-the-counterprescriptions, fitness programs with a gym membership, and much more. Some Medicare Advantage plans even have low or $0 monthly plan premiums. So it’s important to choose a plan that offers the extra benefits that give you more and help you live a healthier life.

When choosing a Medicare Advantage plan, it’s important to look at all the benefits offered by the plan. Take a closer look at the copays, deductibles, out-of-pocket maximums, provider networks, and if your prescriptions are on the plan’s formulary. These are items that can help save you money and determine if you are happy with the plan you choose.

 

Does Medicare Advantage Cover Prescription Drugs?

The answer here is a resounding yes for most plans! Most Medicare Advantage plans include prescription drug coverage (Part D), which means there is no extra Part D monthly plan premium to pay. It’s all-in-one coverage that includes both healthcare and prescription drug coverage.

What you should expect with Prescription Drug Coverage:

• Formulary: Each Medicare Advantage plan has a formulary or list of covered drugs. This list will tell you which medications are covered and what tier they fall under, which can affect the cost.
• Generic vs. brand-name: Formularies typically include both generic and brand-name drugs, offering you choices.
• Cost-sharing: You'll likely have some out-of-pocket costs, such as copays or coinsurance, depending on the drug tier and your plan's specific structure.
• Pharmacy networks: Most plans have a network of preferred pharmacies where you can fill your prescriptions at a lower cost.
• Mail Order: Some plans include mail-order service, which can help reduce your cost and provide the added convenience of having your prescriptions delivered to your home.

 

Does Medicare Advantage (Part C) Cover Dental?

 Yes, most Medicare Advantage plans include some type of routine dental coverage as an added benefit, such as dental exams, cleanings, and X-rays. The dental coverage varies by plan, with some offering additional benefits like extractions, fillings, crowns, root canals, and even allowances that can help pay for treatments. That’s enough to put a smile on your face.

What to do when looking for dental coverage:

Carefully review the details of each Medicare Advantage plan you're considering. The level of dental coverage, the network of dentists, and the out-of-pocket costs can differ significantly.

Don't overlook the importance of dental care. It's an essential part of your overall health and well-being! Take the time to find a Medicare Advantage plan or other option that meets your dental needs.

 

Does Medicare Advantage (Part C) cover hearing aids?

The good news is: Yes, many Medicare Advantage plans do offer coverage for hearing aids, often as part of their benefits.

Not all Medicare Advantage plans offer the same level of hearing aid coverage. Some plans may only cover hearing exams, while others may provide partial coverage for hearing aids. If you need hearing aids or think you might, it’s important to review the specific benefits of each plan you're considering.

Tips for finding hearing aid coverage:

• Read the fine print: Carefully review the plan's summary of benefits or evidence of coverage to understand the specifics of the hearing aid coverage being offered. Pay close attention to any coverage limits, such as annual dollar limits, frequency limits (how often you can get new hearing aids), and the types of hearing aids covered.
• Ask questions: If you have any questions about coverage, contact the plan directly or consult with a licensed insurance agent.
• Consider your needs: Think about your hearing needs and how often you might need new hearing aids or repairs. Choose a plan that offers the right level of coverage for your situation. Even with coverage, you will probably still have a deductible, copay, or coinsurance to pay. You should compare plans to see how much you would pay if you needed hearing aids.

 

Does Medicare Advantage (Part C) Cover Vision

Services?

Most likely, yes! Most Medicare Advantage plans include some vision coverage as part of their benefits. General vision coverage can include routine eye exams, glasses or contacts, so having coverage that can help you see the world better is a definite plus.

Many plans cover annual or biannual eye exams, which are important for detecting and monitoring eye conditions. You might receive an allowance towards purchasing glasses or contact lenses, or the plan may cover a portion of the cost. 

 Key points to consider when looking at vision benefits:

• Coverage levels vary: As with other benefits, the specifics of vision coverage can vary widely among plans. Some plans may have higher allowances for glasses or contacts, while others might offer more extensive coverage for corrective surgery.
• Network restrictions: To get the most coverage, make sure your preferred eye doctor or optometrist is in the plan's network.
• Out-of-pocket costs: Even with coverage, you'll likely have some costs like copays, coinsurance, or deductibles. Be sure to factor these into your decision.

 

Is A Medicare Advantage (Part C) Plan Right for You?

A Medicare Advantage plan could be a great fit if you're looking for an all-in-one healthcare plan with potential extra benefits like prescriptions, dental, vision, hearing, and more. They also often come with lower out-of-pocket costs and an annual cap on expenses, which could help you save money.

What to think about when choosing a Medicare Advantage plan:

• Your healthcare needs: Do you have chronic conditions that require frequent specialist visits? Do you need dental, vision, or hearing coverage?
• Your budget: What are your estimated healthcare costs? Can you afford the monthly premiums, copays, and out-of-pocket expenses of different plans?
• Your lifestyle: Do you travel frequently? If so, a plan with nationwide emergency coverage might be preferable.
• Your preferences: Do you prefer a managed care approach with a primary care physician coordinating your care, or do you want more freedom to choose your providers?

 

Compare Medicare Advantage (Part C) Plans to Find One That Offers What You Need

It's important to remember that not all Medicare Advantage plans are created equal. Each plan is offered by a private insurance company and can have different coverage, benefits, provider networks, and costs.

To find the best plan for you, it's important to do your research and compare your options. The Medicare Plan Finder tool on the official Medicare.gov website is a great resource for this. You can enter your zip code and compare plans side-by-side based on your needs and preferences.

Don't be afraid to ask questions! If you're unsure about anything, reach out to the plan directly or talk to a licensed insurance agent. By understanding your options, considering your needs, and comparing plans carefully, you can find the path to healthcare that suits you best.

Original Medicare doesn’t cover prescriptions, routine dental, hearing, or vision services, so if these are benefits that are important to you - check out a Clover Medicare Advantage plan in your area.