Medicare Advantage plans offer benefits you cannot get with original Medicare. However, Advantage plans usually do not provide the level of coverage you were used to getting through an employer-sponsored health insurance plan. The benefits Medicare does not offer are the ones that aging adults tend to need more than younger people.
Americans have wondered for a long time, when Medicare plans would include coverage that aligns better with the health insurance, they were used to having in employer group policies. There is good news. You will soon have more options available, if you have Medicare Advantage. There will be new Medicare Advantage benefits starting in 2020.
What is Changing
Beginning in 2020, the private insurance companies that sell Medicare Advantage plans will be allowed to offer a range of benefits that fall outside of traditional healthcare coverage. The administrator of the Centers for Medicare and Medicaid Services (CMS) justified the additional options, because the new items can improve or maintain an aging person’s health or function. The expanded coverage you can get, will depend on the specific New Medicare Advantage plan you buy. However, Congress has approved the expansion of plans to include transportation, home meal deliveries and some housekeeping services.
Differences Between Original Medicare and Medicare Advantage Plans
When Medicare started, there was only one plan. We now call that coverage “original Medicare.” As time went by, the government gave private insurance companies permission to offer coverage to people who are eligible for original Medicare. The policies are not identical, so you should educate yourself on all your available options to get the best coverage you can at the right price. Some of the differences between original Medicare and Medicare Advantage include:
- Public versus private plans. The government administers original Medicare plans. Medicare Advantage policies, on the other hand, are private insurance.
- Which doctors and hospitals you can use. With original Medicare, you can go to any doctor or hospital that accepts Medicare. Medicare Advantage is more like a PPO, in that you have to use the doctors and hospitals in the plan’s network.
- Prescription drug coverage. Most Medicare Advantage plans include prescription drug benefits. People who choose original Medicare do not have drug coverage, unless they buy it as an add-on, called Medicare Part D.
- Dental, vision, and hearing. Original Medicare does not offer benefits for dental, vision, or hearing care. Most Medicare Advantage plans include coverage for these services.
- Deductibles and co-pays. People with original Medicare have to buy supplemental policies, if they want help with co-pays and deductibles. Medicare Advantage plans usually pay most or all of these costs.
- Transportation, home meal deliveries and some housekeeping services. As of 2020, Medicare Advantage plans can offer these benefits, but original Medicare will not.
Why Original Medicare Does Not Offer More Options
Congress has to give permission for original Medicare to expand its coverage. So far, Congress has not authorized additional coverage options for original Medicare, but there might be some pilot programs in the future to increase those benefits. As society becomes aware that a holistic approach will improve one’s overall well-being better than merely popping pills, additional non-medical benefits might become available.
AARP. “Medicare Advantage Benefits Expanding (accessed May 2, 2019) https://www.aarp.org/health/medicare-insurance/info-2019/medicare-advantage-expanded-benefits.html