Written by: Vanessa Jerusalimiec (*Amsive Digital) | Reviewed by: Shelley Wyant | *MHP partners with Amsive Digital on news content
What Is and Is Not Covered by a Medicare Advantage Plan?
Medicare Advantage plans offer comprehensive health care coverage. These plans cover hospital and medical care, and may also provide dental and vision coverage, hearing health services, and prescription drug coverage. Here’s a closer look at what is and what is not covered by Medicare Advantage.
Medicare Basics
Medicare offers healthcare coverage to adults 65 and over. Some younger adults living with a chronic health condition or disability can also qualify for Medicare coverage. There are several Medicare Parts:
- Medicare Part A provides hospital coverage
- Medicare Part B provides medical coverage and preventive care
- Medicare Part D provides prescription drug coverage
If you don't want to enroll in multiple plans to get the health care benefits you need, you have another coverage option. A Medicare Advantage plan (Part C) covers Part A and Part B. A Medicare Advantage Prescription Drug (MAPD) plan also covers Part D. Medicare Advantage plans also include a range of added benefits.
What is a Medicare Advantage Plan?
Medicare Advantage plans are a popular alternative to Original Medicare. These plans are offered by private insurance companies, so you have more options. You will get all the same benefits as Original Medicare, along with added benefits which may include prescription drug coverage and more. Medicare Advantage plans also have a range of coverage and cost options, and you can reevaluate your options each year. This means you can get the perfect plan that matches your budget, and your coverage needs.
You can also choose from a range of plan types, each with different benefits and costs. The most common types of Medicare Advantage plans include HMO, PPO, and POS plans.
- Health Maintenance Organization (HMO) plans offer low monthly premiums so your health care stays affordable.
- Preferred Provider Organization (PPO) plans offer greater flexibility when accessing care.
- Point of Service (POS) Plans offer low copays and even more options for accessing out-of-network care.
What Does Medicare Advantage Cover?
All Medicare Advantage plans must cover the same benefits as Original Medicare. This includes hospital care, medical care, preventive care, health screenings, and ambulance services. Just like Original Medicare, Medicare Advantage plans will also cover medically necessary surgeries, services, and medical supplies.
Medicare Advantage coverage doesn't stop there. Most Medicare Advantage plans cover a number of other benefits, which may include:
- Prescription drug coverage
- Preventive dental services including exams and cleanings
- Comprehensive dental services like fillings, crowns, and extractions
- Vision services including eye exams
- Eyewear coverage
- Hearing services including hearing aids
- Fitness membership reimbursement
- Transportation to and from health care appointments
- Worldwide emergency medical care
- Personal Emergency Response System for fall detection and monitoring
- Meals delivered to your home after a hospital stay
- Telehealth services
Each Medicare Advantage plan can offer different benefits. Before enrolling in a plan, compare all the plans available in your area to find the one that fits your coverage needs.
What Is Not Covered by Medicare Advantage
No two Medicare Advantage plans are the same. Each plan provider can choose what services are covered, or adjust plan costs and premiums. The best way to find out what is and is not covered by a Medicare Advantage plan is to check the plan’s Evidence of Coverage. This document will show you exactly what’s covered, what’s not covered, and how much you can expect to pay in copayments or coinsurance.
Medicare Advantage plans will cover medically necessary services or supplies, but you may not get coverage for services considered not medically necessary. For example, cosmetic procedures or cosmetic dental care may not be covered by a Medicare Advantage plan.
What Surgical Procedures Are Not Covered by Medicare Advantage?
Medicare Advantage plans will cover a range of medically necessary surgeries like hip and knee replacement surgery, cataract removal, transplant surgery, a mastectomy, and hernia surgery. You may also receive coverage for restorative surgery. For example, you may have coverage for breast reconstruction surgery after a mastectomy, or plastic surgery after an injury.
Most Medicare Advantage plans will not cover cosmetic surgeries such as plastic surgery, rhinoplasty, or laser eye surgery.
McLaren Medicare in Michigan
The best way to find out what is and is not covered by a Medicare Advantage plan is to ask. Contact us to learn more about our Medicare Advantage plans and find out exactly what’s covered. We have plans to match your health care needs.
Explore Medicare options from McLaren Health Plan, crafted to offer Michigan residents more than just basic coverage. Our plans come with comprehensive benefits and access to a wide network of providers, ensuring your peace of mind.
Discover Our Michigan Medicare Plans