Different Medicare Advantage Plans and Coverage
People with Medicare Advantage Plans get a variety of benefits for a monthly premium (“Medicare Advantage Plans cover all Medicare services”). Not only do the plans pay for “[most] Medicare services,” but also pay for services, such as vision, hearing, dental, emergency treatments, prescriptions, etc., depending on the insurance company under Medicare (“Comparing Medicare Advantage Plans;” “Medicare Advantage Plans;” “Medicare Advantage Plans cover all Medicare services”). Beneficiaries can still utilize traditional Medicare to pay “for hospice care, some new Medicare benefits, and some costs for clinical research studies” (“Medicare Advantage Plans cover all Medicare services”). People could look through a variety of plans that contain rules and regulations affecting their eligibility for coverage.
Insurance companies have different policies that determine their beneficiaries’ coverage. People would have to pay for their own treatments up to an annual limit, which may vary within each plan and “change each year,” before they “pay nothing for covered services” (Jackson 2017b). Insurance companies also offer different types of plans. People usually have to go to doctors in their Medicare Advantage plan’s network for coverage in HMOs, while people can go to doctors inside and outside of their plan’s network for coverage in PPOs (“About Medicare Advantage (Part C) Plans”). A Private Fee-for-Service (PFFS) Plan would cover the beneficiaries’ treatment when the doctor “[accepts] the plan’s payment terms and [agrees] to treat [them]” (“About Medicare Advantage (Part C) Plans”). Special Needs Plans (SNP) pays for treatments and services, such as prescriptions, for “Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions…” (“About Medicare Advantage (Part C) Plans”). When people are in HMO Point of Service (HMOPOS) Plans, they can “get some services out-of-network for a higher cost” (“Different types of Medicare Advantage Plans”). In Medical Savings Account (MSA) plans, people have “a high deductible health plan with a bank account,” with which people spend cash from Medicare “for [their] health care services during the year” (“Different types of Medicare Advantage Plans”). While some plans may not cover certain treatments, patients can make an appeal to the company (“Medicare Advantage Plans cover all Medicare services”). They could guarantee coverage for a medically necessary treatment by requesting “a written advance coverage decision” (“Medicare Advantage Plans cover all Medicare services”).
Despite some of the caveats the insurance companies impose on the beneficiaries, they could look forward to additional benefits. For 2019, the Centers for Medicare & Medicaid Services (CMS) may permit insurance companies to provide more benefits that are “‘medically appropriate’ and recommended by a licensed health care provider,” such as “[air] conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals,” “simple modifications in beneficiaries homes,” “aides to help with daily activities,” etc. (Jaffe 2018). Albeit, people should know that these “benefits should not be items provided as an inducement to enroll” (Jaffe 2018). People could still greatly benefit from Medicare Advantage Plans.
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