Medicare Part C Coverage
3 things to know about what Medicare Advantage plans cover:
- All plans include at least the same coverage as Original Medicare (Parts A and B).
- Most Part C plans provide prescription drug coverage.
- Some plans provide coverage for dental, vision, and wellness programs.
All Medicare Advantage plans provide at least the same coverage as Original Medicare, and some go further to provide additional benefits such as drug, vision, dental, and wellness program coverage.
Before you enroll in a particular Medicare Advantage plan, you should carefully review the benefits.
After you have enrolled, you can always check with your Medicare Advantage plan provider to see if a particular medical service is covered. If you receive treatment that is not medically necessary and not covered, you may have to pay all of the costs. You can request a written advance coverage decision to ensure that the service will be considered medically necessary and will be covered.
Original Medicare benefits
All Medicare Advantage plans include the same standard benefits as Original Medicare.
Medicare Part A benefits include coverage for inpatient hospital stays, hospice care, skilled nursing facility care, and some home health care.
Medicare Part B benefits include coverage for diagnostic services, routine doctor services, outpatient care, medical equipment, and other non-emergency medical care.
Medicare Advantage plans do not cover hospice care. However, you will still get hospice care through Original Medicare even if you are enrolled in a Medicare Advantage plan, according to Medicare.gov.
Many Medicare Advantage plans provide extra benefits such as drug, dental, and vision coverage. Medicare Advantage plan benefits can change from year to year, according to Medicare.gov.
Prescription drug coverage
Most Medicare Advantage plans offer prescription drug coverage.
"In 2014, 83% of Medicare Advantage plans [offered] prescription drug coverage," according to the Kaiser Family Foundation.
Each plan has its own formulary, which is a list of drugs and brand names the plan provider will cover. Before enrolling, you should review a plan’s formulary to ensure that your particular medications are covered.
If your Medicare Advantage plan does not provide prescription drug coverage, you may be able to enroll in a Medicare Part D prescription drug plan (PDP). However, some Medicare Advantage plans, like HMO plans and PPO plans, have rules which prohibit you from enrolling in a PDP.
Dental & Vision
Some Medicare Advantage plans provide extra benefits including vision, hearing, dental, and health and wellness program coverage, according to Medicare.gov.
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.
TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.
Not all plans or products are available in all markets. Additional plans may be available in your service area.
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Last Updated: 8/16/2016