Beyond Original Medicare: An Examination of Medicare Advantage Plans

Benefits of Medicare Advantage

Medicare Advantage plans roll Medicare Part A, B, and often D all into one comprehensive health plan. These plans usually have extra coverage, including dental, vision, and hearing, fitness programs, and wellness services that aren’t available under original Medicare. Additional Medicare Advantage plans exist, including health maintenance organizations (HMOs), Preferred provider organizations, and special needs plans. Deciding the best plan depends on an individual’s health needs and budget.

Enrollment and Coverage Considerations

Eligibility for Medicare Advantage occurs during the Initial Enrollment Period, Annual Enrollment Period, or a Special Enrollment Period. Some factors to keep in mind when making a decision are the network, rules related to coverage details, costs, and benefits such as prior authorizations, service areas, costs—premium, deductible, and copayment—differences between in and out of network, coverage rules, prescription drug formulary, and out-of-pocket maximum.

Original Medicare Vs. Medicare Advantage

Weighing the pros and cons of Original Medicare versus Medicare Advantage must consider health care needs, budget, preferred doctors and hospitals, prescription drug coverages, and the desire for additional benefits like dental, vision, and wellness programs.