What are Medicare Advantage Plans?

A Medicare Advantage Plan, also referred to as Medicare Part C, is an alternative way to receive your Medicare Part A (hospital) and Part B (medical). Medicare Advantage Plans or MA Plans, are offered by private companies that are approved by Medicare. These private insurance companies must follow rules set by Medicare. There are various types of Medicare Advantage Plans which have specific rules about how you receive our Medicare-covered Part A and Part B benefits and any supplemental benefits, discussed in this article, your plan covers.

You will have the same protection and rights as provided by Original Medicare (Parts A and B). ***Note: You

The coverage gap, also known as the “donut hole” is the point when you and your Medicare Advantage Prescription Drug Plan or your Medicare Part D plan have spent a specific set amount on covered medicines (Initial Coverage Limit).

This places a temporary limit on how much your prescription drug plan will cover after you have reached your initial coverage limit. You may need to pay a different percentage of your prescription costs, but it is never more than 25%.

Once you have spent your set amount out-of-pocket, you are no longer in the coverage gap and you are automatically placed into catastrophic coverage.

This means you will pay a small coinsurance or copayment for your covered prescriptions and your Medicare Part D or Medicare Advantage will cover most.

Prevent or Delay Entering the Donut Hole

You can prevent or delay entering the coverage gap

by lowering your prescription drug costs. Here are some

ways to do this:

1. Switch to generic or lower-cost medications. **First talk to your doctor about changing.
2. Enroll in a reputable and well-known prescription drug assistance program or patient assistance program, such as GoodRx, NowRX, Capital Rx, Sempre Health, MDLIVE, and Prescriptive Health.
3. If available from your Medicare Part D plan, use a prescription mail-order program.
4. Apply for the Low Income Subsidy (or LIS) program for extra help. If you qualify, you will not be subject to the Part D coverage gap.

Medicare Advantage and the Annual Notice of Change

If you’re in a Medicare Advantage, your Annual Notice of Change can help you decide whether your existing coverage still meets your health and wellness needs. It is important to note that even small changes in your plan can make a big difference in your healthcare costs. For example, if a specific medical service you depend on is no longer covered, you could end up paying high out-of-pocket costs for that care.

Original Medicare does not include transportation to doctor’s visits. It only covers ambulance services and medically necessary transportation, if you have a medical condition whereby traveling would endanger your health.

Some Medicare Advantage Plans help pay for transportation services that Original Medicare does not cover.

According to the Kaiser Family Foundation (KFF), in 2022, 38% of the Medicare Advantage plans available across the country include transportation as an additional benefit.

Contact Senior Healthcare Advisors to see if transportation is available as an additional benefit in your plan. Ask if prior authorization is necessary for transportation needs.

Telehealth and Medicare Advantage

Currently, Medicare Advantage Plans (Part C) offer broadened telehealth benefits. You can now go to the doctor right on your cell phone. Owning a personal computer is no longer necessary to take full advantage of your Medicare Advantage! “Pun intended”

The Kaiser Family Foundation of Centers for Medicare & Medicaid Services (CMS, 2020) survey data reported one out of every four Medicare beneficiaries use telehealth services. Medicare telehealth services also cover mental health care for many with Medicare Advantage plans.

Senior Healthcare Advisors is moving to increase awareness of telehealth services covered under Medicare Advantage plans.

Medicare telehealth services normally include office visits, consultations, psychotherapy, and other health services that are provided by your healthcare providers who are located elsewhere using video-chat communication technology, like your cell phone or personal computer.

Medicare Advantage Plans offer added telehealth benefits to what was given by Original Medicare. These telehealth benefits are available in various places, and you can go to the doctor from home instead of going to a healthcare facility. Check with Senior Healthcare Advisors to see what additional telehealth benefits it may offer.

Medicare Advantage Over-the-Counter Card

The OTC card is a prepaid debit card that comes with some Medicare Advantage plans. The card is preloaded monthly or quarterly with money that can be used to purchase plan-approved OTC items at in-network locations. Generally, the plan will provide a prepaid debit card that can be used at in-network retailers, however, some plans provide a catalog instead. This catalog allows for browsing and then placing orders online or over the phone to be shipped.

These items are called over-the-counter items because they usually do not require a prescription to acquire – you can typically order them by picking them up in-store or requesting them “over-the-counter” from your local pharmacy. Some popular OTC items include vitamins, cold and flu medicines, pain medicines, sleep aids, allergy medicines, and more.

Some Medicare plans can be more flexible about what items they allow for purchase with the OTC card. Some plans allow medical supplies like shower rails, home diagnostic tests and kits, braces, and supports (for wrist, ankle, knee, elbow, etc.), first aid items, toothbrushes, toothpaste, and more. What is allowed will depend on who the carrier is for the Medicare Advantage plan benefits.

How To Get an Over the Counter (OTC) Card

Step 1. The first step in getting an OTC card benefit is to ensure one is available in your zip code. There are some counties and regions that don’t offer Medicare Advantage plans and some Medicare Advantage plans don’t offer an OTC card. Speak to a licensed Medicare advocate to figure out what is available where you live.

Step 2. You must be enrolled in Medicare Parts A and Part B. The OTC Card benefit is only offered through a Medicare Advantage plan and to enroll in a Medicare Advantage plan, you must have both Medicare Part A and Part B.

Step 3. Ensure the plan has the highest amount of OTC available in the area. Not all Medicare Advantage plans have the same amount of OTC benefit. Some plans have more than others because they are offered by competing Medicare Advantage insurance carriers.

Medicare Advantage Hearing Care Benefits

Original Medicare does not cover hearing benefits like hearing exams, hearing aids, or hearing aid evaluations. For any hearing service that you need, you are required to spend out of pocket.

Just like dental and vision benefits, paying out of pocket is only one choice. Another choice is to receive hearing coverage through a Medicare Advantage plan at no additional cost to you.

Medicare Advantage Dental Insurance

Original Medicare does not cover preventative or comprehensive dental benefits like cleanings, x-rays, oral exams, extractions, fillings, dentures, or implants. Except for minimal denture services that you may receive during a hospital stay, Medicare Part A, hospital, and Part B, medical, does not offer any other dental benefits. For any dental service that you need, you are required to spend out of pocket.

***But hope is not lost. You can get coverage for your dental services when you enroll in a Medicare Advantage plan.

Many Medicare Advantage plans offer coverage for preventive and comprehensive dental services such as:

• Routine Cleaning
• Oral Exams
• X-ray
• Fluoride Treatment
• Fillings
• Implants
• Dentures
• Extractions
• Periodontics and Endodontic Procedures

These benefits are offered at no additional cost through a Medicare Advantage HMO or PPO plan, as long as one is available where you live, you have both Medicare Part A and Part B, and you have a qualifying enrollment period.

Medicare Advantage Vision Benefits

Original Medicare does not cover vision benefits like glasses, contacts, or services like vision exams. For any vision service that you need, you are required to spend out of pocket.

But of course, paying out of pocket is only one choice. The choice is to receive vision coverage through a Medicare Advantage plan at no additional cost to you.

Do I pay extra for vision care on my Medicare Advantage plan?

Many of the Medicare Advantage plans include vision care at no extra cost to you. If you have a monthly premium for your Medicare Advantage, there may be a charge for vision benefits.

***Make sure to talk to a Senior Healthcare Advisors representative to look for vision care options while reviewing Medicare Advantage plans, as they are not included in every plan***

Call: 855-824-6618 TTY/711

Medicare Advantage Fitness Programs

According to Medicare.gov (2022) “Gym memberships or fitness programs may be part of the extra coverage offered by Medicare Advantage Plans, other Medicare health plans, or Medicare Supplement Insurance (Medigap) plans”.

***Disclaimer: A Senior Healthcare medical specialist has reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns with your provider.