As you’re understanding your Medicare options, you may have questions about what’s covered. For example, does Medicare cover routine dental work? Does Medicare cover eyeglasses? When it comes to Original Medicare versus Medicare Advantage, there are some key differences in the types of benefits that you’ll get.
Original Medicare vs. Medicare Advantage
It’s a common misconception that Original Medicare, the government-sponsored health care program, covers everything. Original Medicare includes Part A (hospital stays) coverage and Part B (doctor’s visits and medical procedures) coverage. But when you look more closely, you’ll see that it does not cover things like routine hearing, dental and vision health. Original Medicare also does not provide prescription drug coverage. If you want your prescriptions covered with Original Medicare, in most cases, you will need to join a separate Medicare prescription drug plan (Part D).
According to Angela H., a broker manager with Aetna®, “A lot of people believe that Original Medicare is the end-all be-all when in fact, it’s kind of a building block for whatever else you do, and there are a lot of holes in Original Medicare coverage.”
But with Medicare Advantage (MA), you get added benefits that are not included in Parts A and B. In many cases you can also get hearing, vision and dental coverage and a fitness benefit. Many Medicare Advantage plans also include prescription drug coverage.
Some people may wonder how it’s possible to get these additional benefits with an MA plan and at the same time have little to no additional monthly premium. That’s because unlike Original Medicare, MA plans are managed by private insurance companies, like Aetna.
Original Medicare also doesn’t offer the protection of an out-of-pocket spending limit. This is a cap on how much of your own money you spend on health care bills in a given year. However, all MA plans have an out-of-pocket limit.
Additional Medicare Advantage benefits
One of the main advantages of Medicare Advantage (MA) plans is that many include vision, dental and hearing coverage.
MA plans in general have benefits to help pay for covered services. This coverage may include:
- Dental coverage, including annual cleanings, and X-rays and exams
- Annual routine eye exam and coverage for eyeglasses and contacts
- An annual hearing exam and hearing aid fitting
Read here for more details on the types of vision, dental and hearing coverage.
In addition, some Medicare Advantage plans, known as MAPD plans, include prescription drug coverage. As mentioned above, you can purchase a Part D (drug plan) separately, but the advantage of an MAPD plan is that you get all your Medicare and prescription benefits under one umbrella. “Instead of having multiple cards and multiple places administering your benefits, you have one company that’s going to handle it for you,” says Angela H.
With MA plans, you may also get a fitness benefit which provides gym access and fitness classes.
Surprising Medicare Advantages benefits
While Medicare Advantage plans can contain a number of added benefits, individual plans can vary greatly, so it’s important to research which benefits a plan includes. Here’s a look at some of the lesser-known benefits that may be included with some Aetna MA plans:
- Fall-prevention benefit to help pay for home and bathroom safety products
- Over-the-counter (OTC) allowance: an allowance (included with your plan) to help pay for certain OTC health and wellness products such as bandages and sunscreen
- Freshly prepared meals delivered to your home after being discharged from a qualifying inpatient hospital, inpatient psychiatric hospital or skilled nursing facility stay.
- Alternative therapies like acupuncture or chiropractic services
- Transportation to and from doctor appointments
With MA plans, you can get benefits not typically covered by Original Medicare. And with a variety of MA plan types, you have the freedom to decide the level of coverage that best fits your needs. Many of the extra benefits we offer can help you take a proactive approach to living your healthiest life possible.
What’s covered: Original Medicare vs. Medicare Advantage
Original Medicare includes these benefits:
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Hospital stays
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Medical coverage
Medicare Advantage includes these benefits:
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Hospital stays
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Medical coverage
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Out-of-pocket maximum
Medicare Advantage may also include:
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Vision
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Hearing
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Dental
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Prescription Drugs
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Fitness
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Chronic disease management
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Post-hospital meals delivered
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OTC health products
