What does Medicare Advantage cover that Medicare does not?
Asked by: Aubrey Jenkins | Last update: July 3, 2025Score: 4.1/5 (4 votes)
What is the biggest disadvantage of the Medicare Advantage plan?
Medicare Advantage Plan Pros And Cons
One disadvantage is that some Medicare Advantage plans may offer fewer options when it comes to doctors and hospitals, as they may have smaller plan networks than Original Medicare.
Why are seniors losing Medicare Advantage plans?
Medicare vs Privatized Medicare Advantage
Beneficiaries are tossed aside because they live in an unprofitable market for their insurer or because they are actually using the insurance they signed up for to access services.
What is the biggest difference between Medicare and Medicare Advantage?
Original Medicare helps cover hospital and doctor visits. MA plans bundle Part A and Part B benefits, and some include prescription drug coverage. Many MA plans also include routine dental, vision and hearing care—benefits not offered by Original Medicare.
Why do doctors not like Medicare Advantage plans?
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they're refusing to accept the plans — even big ones like those offered by UnitedHealthcare and Humana.
5 Things Medicare Doesn't Cover (and how to get them covered)
Why are people leaving Medicare Advantage?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
What is the best Medicare plan that covers everything for seniors?
Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.
Can I drop my Medicare Advantage plan and go back to original Medicare?
Medicare Advantage Open Enrollment Period: Between January 1 and March 31 of each year, if you already have a Medicare Advantage Plan (with or without drug coverage) you can: Switch to another Medicare Advantage Plan (with or without drug coverage). Drop your Medicare Advantage Plan and return to Original Medicare.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
What is the two midnight rule for Medicare Advantage?
The two-midnight presumption directs medical reviewers to select Original Fee-for-Service Medicare Part A claims for review under a presumption that hospital stays that span two midnights after an inpatient admission are reasonable and necessary Part A payment.
Why are hospitals not taking Medicare Advantage plans?
Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.
Why do people choose Medicare Advantage over Medicare?
Medicare Advantage plans offer extra benefits, like reduced cost-sharing, dental coverage, gym memberships and debit cards for over-the-counter medical supplies that are not covered by traditional Medicare.
Is Humana pulling out of Medicare Advantage plans?
Humana declined to name the areas; about 560,000 Medicare Advantage beneficiaries impacted. Humana will stop offering Medicare Advantage (MA) in 13 counties in 2025, Humana CFO Susan Diamond said in a published report in Becker's Payer Issues dated Sept.
Do all hospitals accept Medicare Advantage plans?
While most hospitals do accept Original Medicare, there may be some that do not accept Medicare Advantage Plans. However, if you have a medical emergency while you're enrolled in a Medicare Advantage plan, you can seek care at any ER or hospital in the country.
Why is a plan G better than an advantage plan?
Medigap Plan G offers more comprehensive benefits than the Medicare Advantage plan and is more widely available. It also provides more freedom for enrollees. For example, a Medigap Plan G enrollee can visit a specialist without a referral.
Do I still pay Medicare premiums with an Advantage plan?
Medicare Advantage Plan (Part C):
You must keep paying your Part B premium to stay in your plan. Deductibles, coinsurance, and copayments vary based on which plan you join. Plans also have a yearly limit on what you pay out-of-pocket.
Does Medicare Advantage cover 100% of hospital bills?
No. Even though Medicare can cover many of your health care costs, you'll still have some out-of-pocket expenses, including premiums, deductibles, copayments and coinsurance.
What is the best supplemental insurance for Medicare?
- Best for extra plan benefits: Humana.
- Best for straightforward coverage: State Farm.
- Best for extensive medical care coverage: AARP by UnitedHealthcare.
- Best for a range of Medigap plans: Blue Cross Blue Shield.
What are 3 services not covered by Medicare?
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
What is the downside of a Medicare Advantage Plan?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
Which company has the best Medicare Advantage Plan?
- Best Overall, Best for Low Costs: Cigna.
- Also Great for Low Costs: Alignment Health.
- Best for Nationwide Coverage: Aetna.
- Best for Patient Experience, Best for Drug Coverage: Kaiser Permanente.
- Best for Special Needs Plans: Humana.
What is the penalty to switch back to original Medicare?
And, if you decide you want to switch again, there's also no penalty to switch from Original Medicare to Medicare Advantage. You can switch between the two types of coverage as many times as you want. You just need to make the switch during eligible enrollment periods.
Why are hospitals refusing Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
What is the best dental plan for seniors on Medicare?
“My top picks for Medicare Advantage dental insurance include UnitedHealthcare, Cigna, Aetna, Humana and Devoted Health. These companies provide notable dental coverage, and there are different advantages for each. It's important to consider the insurance that the dentists in your area accept and the coverage provided.