Medicare Advantage: Life Insurance Coverage And Benefits Explained

Medicare Advantage, also known as Medicare Part C, is a supplemental plan offered by private companies as an alternative to Original Medicare. It covers non-skilled in-home care, including medication management, personal assistance with bathing and grooming, mobility assistance, and help with catheters or colostomy bags. It also provides post-surgical or recovery services to prevent extended hospital stays. However, it is important to note that Medicare Advantage is strictly health insurance and does not cover life insurance premium costs. Life insurance policies provide financial security in cases of catastrophic injury or death and can assist loved ones with expenses such as funeral costs, which are not covered by Medicare Advantage.

Medicare Advantage vs. Original Medicare

Medicare Advantage (MA) plans are an alternative to Original Medicare. They cover everything that Original Medicare does, and usually include prescription drugs, vision, hearing, and dental care. Medicare Advantage plans are typically cheaper, but they do have some downsides.

Doctor and Hospital Choice

With Original Medicare, you can go to any doctor or hospital that accepts Medicare, anywhere in the US. With Medicare Advantage, you can only use doctors and providers within the plan's network and service area, and you may need a referral to see a specialist.

Out-of-Pocket Costs

With Original Medicare, you pay 20% of the Medicare-approved amount for Part B-covered services after meeting your deductible. This is called your coinsurance. There is no yearly limit on what you pay out-of-pocket unless you have supplemental coverage. With Medicare Advantage, plans have a yearly limit on what you pay for covered Part A and Part B services, and once you reach this limit, you pay nothing for covered services for the rest of the year.

Drug Coverage

Original Medicare does not automatically include prescription drugs. You can choose to buy a separate Part D plan. With Medicare Advantage, most plans include Medicare drug coverage (Part D).

Extra Benefits

Original Medicare does not cover routine physical exams, eye exams, or most dental care. Medicare Advantage plans may offer some extra benefits that Original Medicare does not, such as vision, hearing, or dental coverage.

Prior Authorization

Original Medicare does not usually require approval for services or supplies. With Medicare Advantage, you may need to get approval (prior authorization) from your plan before it covers certain services or supplies.

Travel Coverage

Original Medicare generally does not cover medical care outside the US. With Medicare Advantage, plans generally do not cover medical care outside the US, and there may be restrictions on coverage if you travel outside the plan's coverage area.

Medigap Coverage

You can choose to buy Medigap to help pay your out-of-pocket costs that Original Medicare doesn't cover. With Medicare Advantage, you cannot buy Medigap to cover your out-of-pocket costs.

Switching Plans

It can be difficult to switch out of a Medicare Advantage plan later. If you try to switch to Original Medicare with Medigap during open enrollment, you may find that you have to undergo medical underwriting to get a Medigap plan.

Overall

Medicare Advantage may be a good fit if you are on a tight budget or have a chronic health condition. Original Medicare offers more flexibility and coverage but may cost more each month.

Medicare Advantage and life insurance: what's the difference?

Medicare Advantage and life insurance are two different types of insurance products that serve different purposes. Here is a detailed comparison between the two:

Medicare Advantage (MA):

Medicare Advantage, also known as Part C, is a privately issued alternative to Original Medicare, which is federally run. MA plans cover everything that Original Medicare (Parts A and B) covers and more. This typically includes prescription drugs, vision, hearing, and dental care, all at a low cost. MA plans have networks of providers that you need to use for the lowest costs or your coverage may not pay for out-of-network providers.

MA plans have yearly limits on what you pay for covered Part A and Part B services, protecting you from unexpected high medical costs. However, there are no limits on out-of-network cost-sharing, and you may pay a higher percentage for these services. MA plans may also require preauthorization and referrals for certain types of care, which can be a hassle for some people.

Life Insurance:

Life insurance, on the other hand, is not health insurance but rather a financial product that provides financial security in the event of catastrophic injury or death. It is often purchased by those with the responsibility of supporting a family or by those nearing retirement. Life insurance benefits can assist loved ones with expenses such as estate taxes, funeral costs, and other unexpected expenses.

Life insurance can also supplement Medicare coverage for large expenses, such as long-term care costs. For example, if you require skilled nursing home care, Medicare will only cover up to 100 days, while a life insurance policy can help with the additional costs.

In summary, Medicare Advantage is a type of health insurance that covers a wide range of medical services, while life insurance is a financial product that provides financial protection for your loved ones in the event of your death or serious injury. Both can play important roles in your overall financial and health planning.

Does Medicare Advantage cover air ambulance services?

Air ambulance services are expensive, and it's important to know whether your insurance plan will cover them in case of an emergency. So, does Medicare Advantage cover air ambulance services?

Medicare Advantage (Part C) plans do cover air ambulance transportation when it is deemed medically necessary. This is also the case with Medicare Part B. However, there are certain conditions that must be met for Medicare to cover the costs of air ambulance transportation.

Firstly, the service must be medically necessary, meaning that you require immediate and rapid ambulance transportation that a ground ambulance cannot provide. This could be due to a variety of factors, such as the distance to the nearest appropriate facility or obstacles like heavy traffic. In rural areas, you automatically meet the medical necessity requirement if a doctor or medical professional determines that air transport is necessary due to time and/or geographical factors, and the air transport meets Medicare-approved requirements.

Secondly, Medicare Advantage plans have an annual out-of-pocket spending limit, which Original Medicare does not. The costs and coverage rules may vary depending on your specific Medicare Advantage plan. If you have Original Medicare, Medicare Part B will typically cover 80% of the cost of your air ambulance ride, and you will pay the 20% Part B copayment after meeting your deductible.

It's important to note that Medicare strongly favours ground ambulances due to substantially lower costs. Additionally, Medicare does not typically cover international air ambulance trips since it does not cover treatment and care outside of the United States.

Does Medicare Advantage cover in-home care?

Medicare Advantage, also known as Medicare Part C, is a supplemental plan that covers non-skilled in-home care. It is an alternative to traditional Medicare (Parts A and B), which does not cover non-skilled in-home health care. Most Medicare Advantage plans cover non-skilled in-home care, including medication management, personal assistance with bathing and grooming, mobility assistance, and help with catheters or colostomy bags. They also provide subscribers with postsurgical or recovery services to prevent complications and reduce the need for extended or emergency hospital stays.

Medicare Advantage plans are sold through independent insurance companies, so some benefits may vary by company and region. All Medicare Advantage plans must provide at least the same level of home health care coverage as Original Medicare, but they may impose different rules, restrictions, and costs. Depending on your plan, you may need to:

• Get care from a home health agency (HHA) that contracts with your plan
• Request prior authorization or a referral before receiving home health care
• Pay a copayment for your care (Original Medicare fully covers home health)

If you need skilled nursing home facility care, Medicare insurance will pay for up to 100 days of care for each illness. Medicare will cover 100% of the first 20 days, and you will be responsible for a daily co-pay for days 21-100. After day 100, you will pay the full cost. However, Medicare coverage does not extend to custodial long-term care in a nursing home, assisted living facility, or at-home. You are responsible for the cost of the facility and any custodial care you receive.

What are the disadvantages of Medicare Advantage?

Medicare Advantage is an increasingly popular alternative to Original Medicare. However, it does have some disadvantages.

Problems With Switching

Medicare Advantage plans can be difficult to switch out of later. If you try to switch from Medicare Advantage to Original Medicare with Medigap during open enrollment, you may find that your guaranteed issue period has passed. This means you'll have to undergo medical underwriting to get a Medigap plan to help cover extra expenses.

Restrictions on Care Access

Medicare Advantage plans restrict your choice of providers and require pre-authorisations and specialist referrals for many types of care. You may only be covered for emergency situations if you travel outside of your specific geographic area.

Limited Provider Networks

Medicare Advantage plans often have smaller networks of doctors and hospitals than traditional Medicare, which can limit your choice of providers. If you opt for a health maintenance organisation (HMO) plan, you'll only be covered if you see in-network doctors (except in emergencies). A preferred provider organisation (PPO) plan will give you the option of seeking care out of network, but you'll pay more for those services.

Limitations on Extra Benefits

Medicare Advantage plans often include extra benefits such as dental, vision, and hearing care. However, these benefits often come with dollar limits on how much care is covered in a year, which may be lower than you expect. For example, the average vision coverage limit is $160, which is much less than the cost of glasses.

Overwhelming Choices

With 98% of Medicare beneficiaries having 10 or more Medical Advantage health plans available in their area in 2025, the number of choices can be overwhelming. It can take a lot of time and effort to search for a good plan.

Frequently asked questions