What Does Medicare Advantage Cover?

What Does Medicare Advantage Cover?

It depends on which plan you and your doctor choose. (And, as always, you should know that your plan may change at any time.) Here are some of the services it usually covers:

A primary care doctor who can help you with your regular health care

Specialists -- like a cardiologist or urologist -- that your primary care doctor refers you to

An annual wellness visit

Diagnostic and lab tests

Preventive care services like a flu shot

Prescription drugs, including both brand-name and generic versions

And here are some services it might cover:

Some of your hospital costs when you have a short stay for a planned procedure, like a cataract removal or heart surgery

Emergency care

Home health care

Some medical equipment

Some types of mental health care and drug addiction treatment

(Medicare has a detailed list of what it covers and what it doesn't.)

What does Medicare Advantage cost?

It depends on the plan, but the total cost will be the same each year. With original Medicare, you pay deductibles, co-pays, and coinsurance for some services. These costs don't change from year to year. With Medicare Advantage, you pay a monthly premium to the plan. This amount will change each year. (See what Medicare Advantage costs.)

How do I choose the best plan for me?

You'll want to think about your health, your doctors, and how you get health services.

(Medicare has a simple tool you can use to compare plans.)

If you don't have a regular doctor, you may want to find a plan that has a good network of doctors and other providers in your area. Or, if you already have a primary care doctor, you'll want to consider a plan that accepts your doctor.

Medicare Advantage plans often have a list of doctors and providers that they recommend to members. If you can't find a primary care doctor on this list that you're comfortable with, look for a plan with a doctor that you do like.

You should also think about how often you visit the doctor. Some plans cover a lot of visits and services, while others don't.

The plan you choose can help you with things like:

Your vision, hearing, and dental care

Medicine and medical supplies

In-home services

Health education and counseling

And, if you live in a nursing home or assisted living facility, some Medicare Advantage plans can help with those expenses, too.

You can learn more about this topic by reading About Medicare Advantage Plans.

What Medicare Advantage plans are available in my area?

Medicare Advantage plans are available in most areas of the country. Here's a list of the Medicare Advantage plans available in your area. (It includes the plan's name, Star Rating, and the counties where it's available.)

In some areas, you may have to choose among several Medicare Advantage plans. And, if you don't choose one of these plans, you'll be put into Original Medicare and can join a Medicare Advantage plan later if you want.

When can I join a plan?

You can join a Medicare Advantage plan anytime, but you should sign up during the Annual Enrollment Period, which is October 15 - December 7. If you miss this enrollment period, you'll have to wait until the next year to sign up.

What if I can't decide on a plan?

If you don't want to join a Medicare Advantage plan or join the plan you were put into, you can do nothing. You'll be automatically assigned to a plan that's available in your area.

If you don't want to be in Original Medicare, but you can't decide on a Medicare Advantage plan, you may be able to join a plan in the future.

(You'll need to be in Original Medicare for at least a few months before you can change to a Medicare Advantage plan.)

What if I change my mind?

You can always switch plans. You may be able to use a special enrollment period to join a Medicare Advantage plan or switch to Original Medicare, if you qualify.

If you have a Medicare Advantage plan now, you can switch to Original Medicare.

If you're in Original Medicare, you can switch to a Medicare Advantage plan.

(You'll need to talk with the plan about the process to make sure it's done properly.)

Who can help me understand Medicare Advantage?

If you're confused by all this Medicare Advantage stuff, you're not alone. Here are some resources you can use to learn more:

If you have questions about your Medicare Advantage plan, you can always call the plan directly. They'll be able to help you understand your benefits and how to use them.

Updated September 2015

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