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Some people – especially those with health problems – live in fear that their health insurance companies might deny them coverage, or charge huge amounts of money. What about Medicare Advantage plans? Here’s some information about what these plans must cover, and whether Medicare Advantage plans can deny coverage.
For the most part, Medicare Advantage plans cover everything that Original Medicare (Part A and Part B) covers. The private insurance companies offering Medicare Advantage plans contract with Medicare to deliver Part A and Part B benefits to you, and are bound by Medicare rules.
Medicare Advantage plans don’t cover hospice benefits – but don’t worry. If you should ever need hospice benefits while you have a Medicare Advantage plan, Medicare Part A will cover them. You might pay a copayment of up to $5 for prescription medications. Most covered care must be at home, but Part A might cover limited hospice care in a facility in some situations.
Medicare Advantage plans usually cover prescription drugs (although not all plans do). Since each plan with drug coverage has its own formulary (list of covered drugs), you may want to check plan formularies before signing up for a plan. A plan can change its formulary anytime, but the plan will notify you when necessary.
There are a lot of Medicare Advantage plans that offer coverage beyond Part A and Part B. For instance, some plans offer routine vision care. This is another reason that you may want to compare the plans available in your area – see what extra benefits each one offers, if any, and whether it covers your medications. One easy way to compare plans is to click the Browse Plans button on this page.
If you’re eligible for Medicare, and you want to enroll in a Medicare Advantage plan, here’s some good information to know. A Medicare Advantage plan can’t deny you coverage if you have a health problem (except for end-stage renal disease). That’s assuming that you live within the plan’s service area and are enrolled in Medicare Part A and Part B when you apply for the plan. If you have end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant), you generally can’t enroll in a Medicare Advantage plan, except for a Special Needs Plan.
There are some situations when a Medicare Advantage plan might not have to cover your medical services. Here are a few examples:
If your Medicare Advantage plan denies coverage of a medical service that you think it should cover, you can file an appeal.
If you’re not satisfied with how your plan treated you, you can file a complaint, called a grievance. Your state health insurance assistance program (SHIP) can help you.
To compare Medicare Advantage plans with the click of a button, just click the Browse Plans button on this page.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.