Clinical trials, hospice care, and, temporarily, some new benefits resulting from legislation or national coverage rulings are the only benefits that Medicare Advantage Plans do not cover when providing all of your Part A and Part B benefits. All emergency, urgent care, and nearly all medically required treatments that Original Medicare provides must be covered by plans. Even if you have a Medicare Advantage Plan, Original Medicare will still help pay for some new Medicare benefits, some expenditures associated with clinical research trials, and hospice care.
Services that are not medically required under Medicare may not be covered by the plan. Before receiving a service, ask your provider if it is covered if you are unsure.
A Medicare Advantage Plan may provide coverage for benefits that Original Medicare does not, such as some vision, hearing, and dental services, as well as fitness programmes (gym memberships or discounts) (like routine check ups or cleanings). Plans may also include additional benefits. For instance, some plans may provide coverage for things like doctor visit transportation, over-the-counter medications that Part D doesn’t cover, and services that support your wellness and health. Before enrolling, inquire about the benefits offered by the plan, check if you might be eligible, and learn about any restrictions.
Plans can also modify their benefit packages to give some subscribers with chronic illnesses extra advantages. Benefits from these packages will be tailored to address certain circumstances. Although you can inquire about these benefit packages with a Medicare Advantage plan before enrolling, you’ll need to wait until you do so to find out if you’re eligible.
The majority of plans offer Medicare Drug Coverage (Part D)
You typically pay a monthly fee for the Medicare Advantage Plan in addition to your Part B cost.
The regular Part B premium will cost $170.10 in 2022 ($164.90 in 2023). (or higher depending on your income).
You can be required to cover the whole cost of a service if you require it but the plan deems it not to be medically necessary. However, you have the option to challenge the judgement.
You have the right to an organisation determination, either verbally or in writing, to find out if a service, medication, or supply is covered if you have a Medicare Advantage Plan.
To obtain one, speak with your plan and adhere to the guidelines to submit an appeal on time. A plan-directed care approach is another option. When a plan provider refers you for a service or to an out-of-network provider without first obtaining an organisation determination, this occurs.
If a network provider did not receive an organisation determination and either of the following is true, you are not required to pay more than the standard cost-sharing under the plan for a service or supply:
- You received services or materials from the provider that you reasonably believed were covered, or they recommended them to you.
- For plan-covered services, the provider directed you to an out-of-network provider.
Contact your plan for more information. Get your plan’s contact information.
