Medicare "Gaps"

& How To Fill Them

 

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Medicare Advantage - This Page

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Medicare Advantage

Medicare Advantage (Part C)

Medicare Advantage, also known as "Part C", are health insurance plans provided by private insurance carriers. Medicare Advantage plans do not supplement Medicare, they replace it. Advantage Plans provide Part A and B benefits (hospital & outpatient) but also include extra coverage to help fill the gaps. These extra's can include reasonable copays for medical care, an out of pocket maximum, prescription, and dental & vision benefits

 

Many Medicare Advantage plans provide these additional benefits for little or no extra monthly cost to what you pay for Medicare.

Medicare Advantage Facts

Medicare Advantage Plans typically bundle medical, prescription, dental & vision in one plan.

 

Available Medicare Advantage plans and benefits are based on your county.

 

Medicare Advantage plans replace Original Medicare and become your insurance.

 

Medicare Advantage plans have doctor and hospital networks that have agreed to accept the plan.

Medicare Advantage  - A Picture

As mentioned above, Medicare Advantage includes all of your benefits in one plan rather than separate parts. Here's what that looks like.

Part A Hospitalization & Part B Outpatient

Part D Prescription Pharmacy Benefits

Dental & Vision Coverage

Medicare Advantage Plans are "bundled" and include all benefits in one plan.

Filling The Gaps

Now that you have an understanding and picture of how this set up looks. Let's take a closer look at the Gaps mentioned in this guide and how Medicare Advantage plans cover them.

Medicare Advantage

Gap # 1

Part A Deductible 

& Copays

When you are covered by a Medicare Advantage plan you will more than likely not have a deductible for hospital stays but you will have a copay. This copay will vary depending on the plan. How Medicare Advantage helps fill this gap is not by completely covering it but by setting limits to your cost.

Gap # 2

Part B Deductible 

& Coinsurance

With Medicare Advantage you will more than likely not have a deductible for medical care under Part B. For some types of care you will have $0 copay, for others, you may have a copay or coinsurance. Just like with hospitalization, Medicare Advantage helps fill this gap by giving you reasonable copays for medical care and providing you with limits to your costs.

Gap # 3

Annual Out Of Pocket Maximum

All Medicare Advantage plans give you an annual out of pocket maximum for your medical expenses. If your copays for the calendar year reach your plan's maximum, you have no more out of pocket costs for the year. The out of pocket maximum can be lower or higher depending on the type and specific plan you have.

Gap # 4

Prescription Pharmacy Benefits

Gap # 5

Dental & Vision Coverage

Part D prescription coverage is typically included with Medicare Advantage plans. Covered medications and your copays vary with the different plans.  These benefits help you pay for medications at the pharmacy.

Dental and Vision benefits have now become a staple of Medicare Advantage and are typically included. The amount of coverage & benefits you get will vary with the different plans. Most plans with cover routine Dental & Vision exams, eye wear, teeth cleanings, and  teeth restoration.

Medicare Advantage premiums in Texas typically range from $0 to $55 per month in 2020. The monthly premium is in addition to what you pay for Medicare. The standard Medicare premium is $144.60 per month in 2020.

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