Confused by the ABCs of Medicare?
Medicare Parts A and B are the most basic form of Medicare. However, these only cover inpatient and outpatient care, without addressing many of the most expensive items that can affect you as you age.
For example, you may not have prescription drug coverage. Without it, you might have to pay thousands of dollars out of pocket each year to fill a prescription for a chronic condition. Many can’t afford these medical expenses and end up not filling their prescriptions or skipping doses.
If you are looking for a Medicare plan that covers everything, you need a Medicare Part C plan. This is also known as Medicare Advantage. These are private insurance health plans that cover the entire spectrum of Medicare Part A and B, and even more.
This post breaks down what health care services a Medicare Advantage plan covers.
Medicare Part A: Inpatient Care and Home Health Care
Medicare Part C includes the inpatient, nursing facility, hospice, and home care coverage that is included in Medicare Part A. However, copay costs may be cheaper with Medicare Part C.
It is important to make sure that any facility in which you are Medicare-certified.
Hospital Care Coverage
Medicare Part C covers hospital expenses deemed critical to your care. This includes any drugs that are administered by a health care professional. Eligible facilities include:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehab facilities
- Long-term care
- Mental health facilities
Home Health Care
Medicare Part C covers home care services that are deemed medically necessary by a doctor. Services include:
- Home skilled nursing care
- Physical therapy
- Speech-language pathology
- Occupational therapy
- Medical social services
- Part-time health aide
- Medical equipment (included in standard Medicare Part B)
Nursing Facility Care
A stay in a nursing facility is covered if the stay is a minimum of three days, not counting time spent in observation or the day of admission or discharged. Services include:
- Semi-private room
- Skills nursing services
- Rehab services
- Medications and medical equipment
- Ambulance transportation in an emergency
Hospice care can be covered if a doctor certifies you have less than six months left to live. You must agree to give up curative treatments and focus on palliative care. Most hospice care coverage occurs in the home. Services include:
- Doctor and nursing services
- Pain relief medications
- Social services
- Medical equipment
- Hospice aide services
- Personal Support Worker
- Physical and occupational therapy
- Dietary counselling
- Short-term inpatient care
- Short-term respite care
Medicare Part B: Outpatient Care and Preventative Medicine
Medicare Part C also includes the outpatient, medical equipment and preventative medicine benefits of Medicare Part B. However, copay costs may be cheaper with Medicare Part C. Medicare Part B services include:
- Chiropractic care (in medically necessary situations)
- Diagnostic tests and lab work
- Doctor office visits
- Durable medical equipment (DME)
- Home health services
- Outpatient physical, speech or occupational therapy
- Outpatient mental health services
- Preventive-care services (screenings, vaccines etc.)
- Some ambulance services
Medicare Advantage Extra Benefits
The major advantage of Medicare Part C is the Advantage benefits. Along with including Part D prescription drug coverage, you also get access to services not included in basic Medicare: dental, vision, hearing and fitness benefits.
Prescription Drug Coverage
Medicare Advantage includes Part D coverage for prescription drugs. All filled prescriptions will be subject to coinsurance or copayment, the amount of which depends on your plan and the brand of drug.
Learn more about the benefits and pricing structure of Medicare Part D in our related post: Choosing The Best Prescription Drug Plan Option.
Routine and Emergency Dental
Dental is not covered in basic Medicare. The dental services/amount covered will differ from plan to plan. Dental services a Medicare Advantage plan may include are:
- Dental exams and cleaning
- Root canals
Routine Vision and Eyeglasses
Routine eye exams and prescription eyeglasses coverage are offered by many Medicare plans.
Routine Hearing Care and Hearing Aids
Routine hearing tests and hearing aid coverage are offered by many Medicare plans. You need to be particularly careful that when you purchase a hearing aid you make sure the device brand and supplier are covered.
Many Medicare Advantage plans provide or subside a gym membership or fitness classes. This varies from plan to plan.
Compare Medicare Advantage Plans Today
The benefits of Medicare Part C are wide-ranging, but each Medicare Advantage plan is very different. You will want to make sure you compare a wide variety of plans to choose one that suits both your budget and your needs.
At Call4SeniorServices, our mission is to help you make the best Medicare decisions for your budget. Our agents will provide a free consultation where they discuss your needs with you and provide you with different provider and plan options for you to choose from.
Let Call4SeniorServices be your one-stop shop for Medicare Advantage plan shopping.