Page Reviewed / Updated - August 24, 2020
Seniors can access a broader range of benefits through Medicare Advantage plans than the federal government's Original Medicare program. Some plans may also provide lower out-of-pocket costs because of cost-sharing.
Seniors aged 65 and over are eligible for Medicare coverage. The federal government's health plan ensures older adults are covered for medically necessary services. This includes hospital, nursing home, hospice and home health care (Part A) and medical appointments to diagnose and treat a condition (Part B).Seniors may add on optional prescription drug coverage (Part D) to their Part A and Part B coverage.
Medicare Advantage, also known as Part C, is offered by private insurance companies. It was introduced in the 1980s to provide competition and choice. Seniors may find that these private plans offer convenience, a wider range of benefits and lower out-of-pocket costs than Original Medicare.More than 3,100 Medicare Advantage plans are available nationwide as of 2020, with the average beneficiary being able to choose from 28 different plans.
Medicare Advantage plans package Medicare Part A, B and D coverage with additional supplemental benefits. This provides seniors with the convenience of a comprehensive, all-in-one plan through a single provider.Some plans are also tailored to best serve those with certain chronic health conditions, delivering a customized package of benefits, health care providers and prescription drug coverage.
Medicare Advantage plans are permitted to provide more benefits to members than Original Medicare. More than 80% of plans provide some dental, vision, hearing or fitness benefits. Additional eligible services may include transportation to medical appointments, meal delivery, nutrition counseling, cooking classes, in-home support, telemedicine, acupuncture and chiropractic care.
Many seniors prefer Medicare Advantage plans because they typically cost less than Original Medicare. Some plans may charge a $0 monthly premium, although all Medicare beneficiaries must pay the Medicare Part B monthly premium, regardless of which plan they're enrolled in.
Medicare Advantage plans also have an annual out-of-pocket spending limit, after which the plan pays 100% of eligible costs.
Medicare Advantage plans tend to have lower out-of-pocket costs than Original Medicare because of arrangements made with their network of health care providers. While this allows the plan to pass savings onto members, seniors are usually limited in which providers they can use for services. Members may also be unable to access health coverage outside of their plan's service area, except in emergencies.
There are many factors to consider when choosing the right Medicare plan. Seniors wanting a broad range of benefits may find Medicare Advantage is an ideal choice, but it's important to compare the benefits and out-of-pocket costs of different plans to find one that works best for their health needs.