If you are eligible for Medicare, you might wonder how Medicare Advantage Plans work. The Medicare Advantage program is an alternative to Original Medicare. Medicare was introduced in 1965 as a federal social insurance plan to provide health insurance to senior residents.

But what is Medicare Advantage, and how do Medicare Advantage plans work? Let’s dive deeper into what exactly Medicare Advantage is and the services it covers.

What is Medicare Advantage, and What Services Does It Cover?

Medicare Advantage, also called Part C or MA Plans, are health plans provided by private companies approved by Medicare, which means that private companies offering MA plans must adhere to rules set forth by Medicare. Moreover, MA plans cover more services than traditional Medicare.

Medicare Advantage allows you to get more from Part A and Part B coverage. These plans must at least cover what Original Medicare covers plus added benefits. As a result, more and more people have been enrolling in MA plans. In 2022, approximately 48 percent, or over 28 million people, of those eligible for Medicare enrolled in a Medicare Advantage plan.

In addition to covering what Original Medicare covers, most Medicare Advantage plans have added health-related services such as vision, dental, hearing, and prescription drugs. Medicare Advantage plans provides various services and benefits, some of which include:

  • Medicare Part A (Hospital): This is what Original Medicare covers and must be included in Medicare Advantage plans. Part A covers the resident’s care in hospitals, emergency access, and professional nursing. However, it doesn’t include long-term or custodial care.
  • Medicare Part B (Medical): This must also be included in Medicare Advantage plan coverage because it is available in Original Medicare. It covers medically necessary services and preventive services. Other services include:
    • Outpatient and inpatient care
    • Mental health
    • Ambulance services
    • Clinical research
    • Doctor’s services
    • Durable medical equipment (DME)
  • Vision, dental, and hearing coverage: Medicare Advantage plans may cover non-medically necessary services not included in Original Medicare. However, the amount of coverage will differ from one MA plan to another.
  • Prescription drug coverage (Part D): Almost all MA plans cover drug prescriptions, which isn’t usually covered under Original Medicare. Statistics reveal that 23 percent of senior residents find it challenging to pay for prescription drugs. Therefore, Medicare Advantage plans that cover prescription drugs are advantageous.
  • Health-related perks: Some Medicare Advantage plans include:
    • Medical transportation,
    • Gym memberships, and
    • Meal delivery

How Do Medicare Advantage Plans Work?

Medicare Advantage plans provide additional coverage. Your choices may be limited because most MA plans have provider networks. The plan may not cover your care, or the cost may be significantly higher, if you go outside the plan’s provider network.

Medicare pays a fixed amount monthly to companies offering MA plans. However, the companies charge different out-of-pocket costs depending on the plan and what it covers. Furthermore, each plan has varying rules on how to access their services.

For instance, you may require a referral to see a specialist. You may also need to visit doctors and get supplies from providers that belong to the MA plan for non-emergency care.

Who’s Eligible for a Medicare Advantage Plan?

Any person enrolled in Original Medicare Parts A and B can sign up for a Medicare Advantage plan. These are senior residents above the age of 65. MA plans also cover people under 65 years who qualify for Medicare due to a disability.

How Do Align Senior Care Plans Work?

Align Senior Care offers different plans for personalized attention and compassionate care. All of these plans aim to improve senior living residents’ quality of life. Align Senior Care offers the following Medicare Advantage special needs plans:

  • Institutional special needs plans (I-SNPs),
  • Dual-eligible special needs plans (D-SNPs), and
  • Chronic special needs plans (C-SNPs)

Choose Align Senior Care: Personalized Healthcare for You

Align Senior Care understands what Medicare Advantage is and its role in improving senior residents’ quality of life. Contact us today for a personalized healthcare solution.

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