Medicare Advantage

This blog section contains information on Medicare Advantage plans. Learn about Medicare Part C and discover when you can change your plan during the Open Enrollment Periods. Moreover, find out about Silver Sneakers, Dental Plans, and compare Supplement plans to Medicare Advantage plans.

Senior man pays for prescription drugs at pharmacy

Can I Change My Medicare Advantage Plan Now?

You can change your Medicare Advantage Plan now – from January 1 to March 31. Otherwise, you will need special circumstances to qualify for a Special Enrollment Period (SEP). If you do not qualify for SEP and it’s past March 31, you will need to wait until the Annual Election Period from October 15 to December 7.

Estimated reading time: 2 minutes

Why change your Medicare Advantage (MA) plan?

Senior couple visits doctor
Get an MA Plan with your doctors and medications.

3 Reasons to Change Your Medicare Advantage Plan

Top 3 reasons why seniors change their Medicare Advantage (MA) Plan:

MA Plan Costs

You may be overpaying because your doctors or prescription drugs are out-of-network. Furthermore, your out-of-pocket limits may also be too high. For example, you have a zero or low monthly premium, but your copayments and other out-of-pocket expenses are too much. 

You can now change your MA Plan with a higher monthly premium and a lower annual out-of-pocket limit. As a result, you will spend less per year. Your costs are also related to your coverage.

MA Plan Coverage

If you have a Medicare HMO plan and your doctor is out-of-network, your MA plan does not cover these doctor bills. However, Medicare PPO plans do cover doctors out-of-network at higher costs. To avoid the expense of out-of-network doctors, make sure your doctor is in-network.

For better coverage, you may want to change your MA plan now from HMO to PPO. Drug coverage is another reason to change your MA Plan.

MA Drug Plan Coverage

Some MA Plans have no drug coverage, while other MA plans include drug coverage. If your MA Plan does not include drug coverage, you can change your Medicare Advantage plan now.

Furthermore, your MA Plan with drug coverage may not include all your prescriptions. In this case, we recommend you change your MA plan now, so all your prescription medications are covered.

Senior man pays for prescription drugs at pharmacy

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Does Medicare Cover Prolia?

Does Medicare cover prolia senior woman in wheelchair with nurse

Medicare Part D or Medicare Advantage plan may cover the injectable osteoporosis drug Prolia. When you are in a hospital or skilled nursing facility, Medicare Part A can help pay for Prolia. Furthermore, Medicare Part B may cover a home health nurse visit to inject this drug.

Estimated reading time: 7 minutes

Medicare Coverage for Osteoporosis Drug Prolia

Does Medicare Cover Prolia? injection in arm of senior woman by male nurse

To enroll in a Medicare Advantage plan, you must have both Medicare Part A and Part B. Furthermore, to have Prolia drug coverage, your Medicare Advantage plan must include drug coverage. However, if you have original Medicare, you can get a standalone Part D drug plan by having Medicare Part A or Part B.

Medicare Eligibility for Osteoporosis Drugs

To be eligible for osteoporosis drugs, you must meet the following conditions:

  • Be a woman
  • Have a bone fracture that a doctor certifies is related to postmenopausal osteoporosis

To be eligible for Medicare home health services, you must meet the following conditions:

  • You have Medicare Part B
  • Your doctor certifies you are unable to learn to give yourself the drug by injection
  • A family member or caregiver is unable and unwilling to give you the drug by injection
Does Medicare Cover Prolia? Senior woman with osteoporosis  consults with home health nurse

Furthermore, a doctor must certify you are homebound and do not need more than part-time or intermittent skilled nursing care. If you meet the above conditions, Medicare will cover Prolia injections by a home health nurse.

What is Osteoporosis?

According to the Mayo Clinic, osteoporosis “causes your bones to become weak and brittle.” Osteoporosis is most commonly found in white senior women who are past menopause. CDC.gov data shows 24.5 percent of women 65 years old and over have osteoporosis of the femur, neck, or lumbar spine. Thus, 1 in 5 female seniors has osteoporosis.

Symptoms of Osteoporosis

You may have osteoporosis if you have the following signs and symptoms:

  • Back pain caused by a fractured vertebra
  • Loss of height over time
  • A stooped (bent over) posture
  • A bone that breaks easier than expected
Senior woman in kitchen with back pain
Senior woman in kitchen with lower (lumbar) back pain.

How to prevent osteoporosis?

The Mayo Clinic says, “good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.” Read the article, Senior Fitness Programs, to learn how you can become more active and improve your strength, balance, and more! To maintain healthy bones, women age 50 and over need 1200 milligrams of calcium (Ca). The following foods are good sources of calcium (per 100 grams):

  • Dairy products such as cheddar cheese (707mg)
  • Silk soy milk (450mg per cup)
  • Canned sardines with bones (382mg)

If you consume less than 1200mg per day, please consider taking a calcium supplement. However, consuming too much calcium is associated with kidney stones. Furthermore, too much supplemental calcium may increase your risk of heart disease. Thus, please limit your calcium intake to 2,000mg per day.

Seniors seated lifting weights in Ger-Fit class
Seniors lifting weights in a Geri-Fit class.

In addition to calcium, you also need Vitamin D for healthy bones. So how much vitamin D do seniors need?

Vitamin D and Osteoporosis Prevention

According to the fact sheet at NIH.gov, Vitamin D helps your body absorb calcium. By consuming recommended amounts of calcium and vitamin D, you can help prevent osteoporosis. Adults 19-70 need 15 micrograms (mcg) or 600 International Units (IU). However, seniors over the age of 70 need 20mcg or 800 IU.

Vitamin D Foods

Very few foods contain vitamin D. However, the US fortifies some food with this vitamin. Please check vitamin D on the product Nutrition Facts label. The following foods are excellent vitamin D sources with a Daily Value (DV) of over 20%.

  • Salmon baked (13.7mcg 68% DV)
  • Canned tuna (6.70mcg 34% DV)
  • Canned sardines with bones (4.8mcg 24% DV)
Senior woman making a lox with salmon cream cheese and bagel
Senior woman making a lox with salt-cured salmon, cream cheese, and bagel.

Furthermore, soy milk and whole milk fortified with vitamin D (3mcg 13% DV) are good sources of vitamin D.

Medicare Costs for Prolia Injections

Your Medicare costs will depend on who administers your Prolia injection and your Medicare plan. If you have Original Medicare and self-administer Prolia inject, your Part D drug plan covers the cost.

However, if you have Original Medicare and a home health nurse administers your Prolia injections, Part B covers 80% of the drug cost. Consequently, you pay the annual Part B deductible, monthly Part B premium, and 20% of the drug price.

Medicare Advantage Prolia Costs

If you have a Medicare Advantage (MA) plan without drug coverage and self-administer Prolia injections, your drug costs are not covered. Consequently, the list price you would pay maybe $1278. To avoid paying such a high price, we recommend you switch to a Medicare Advantage plan with drug coverage. Otherwise, have a home health nurse administer Prolia. Then your cost is only Medicare Part B deductible, the monthly premium, and your MA plan costs.

However, if you have a Medicare Advantage plan with drug coverage, the costs are similar no matter who administers Prolia injections. For example, you can administer Prolia injections yourself or have a home health nurse do it, and your Medicare costs are about the same. You pay Medicare Part B and your Medicare Advantage plan costs.

Medicare covers the costs of Prolia injections.

Are you at Risk for Osteoporosis?

Some medical conditions put you at greater risk for osteoporosis. For example, estrogen deficiency could put you at higher risk for bone loss. Furthermore, if you are diagnosed with primary hyperparathyroidism, your parathyroid gland(s) enlarge, increasing the blood’s calcium levels. As a result, less calcium enters your bones, causing osteoporosis. (Mayo Clinic)

X-rays can show signs of osteoporosis, osteopenia, or vertebral fractures. Also, taking steroid medications can lead to bone loss and cause osteoporosis. For example, long-term use of Prednisone (Glucocorticoids) may result in bone damage. (Osteoporosis.ca)

If you are at risk for osteoporosis, Medicare pays for the costs of bone mass measurements (bone density tests). Every two years, Medicare covers this cost to evaluate your risk of broken bones.

DEXA bone density test machine female senior
DEXA machine measures bone density in hip and spine to diagnose osteoporosis.

Furthermore, this Medicare-covered test helps your doctor monitor your osteoporosis drug therapy to see if Prolia injections are working. (Medicare.gov)

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Medicare Kidney Transplant

Medicare Kidney Transplant

Does Medicare pay for a Kidney Transplant?

Original Medicare Part A and Part B pay for kidney transplants. Furthermore, Medicare Advantage (Part C) also covers kidney transplants. So what exactly is a kidney transplant?

Estimated reading time: 5 minutes

Kidney Transplant Surgery

Kidney transplant surgery is a medical procedure to remove a healthy kidney from a donor and transplant it into the receiver. The receiver’s non-functioning kidney remains in place, and the surgeon adds the new kidney to the receiver’s abdomen. Kidney donors can live with only one kidney. So what services does Medicare cover?

Medicare Part A Kidney Transplant Services

Medicare Part A covers kidney transplant services for you and your donor. Medicare pays for your inpatient hospital services, the kidney registry fees, blood, and the cost of finding a kidney donor. Furthermore, Part A covers laboratory tests and exams to evaluate your medical condition and potential kidney donors’ condition. 

Kidney Donor Coverage

Medicare covers the full cost of care for your kidney donor. Specifically, Medicare covers donor care before, during, and after surgery. Furthermore, should your donor need additional hospital care after surgery, Medicare covers this care as well. 

Medicare Kidney Transplant surgery
Medicare Part A covers kidney transplant surgery.

When you enrolled in a Medicare Advantage plan, did you check if a transplant specialist was in your plan’s network?

Medicare Advantage Kidney Transplant Specialist

Kidney Transplant Specialist doctors

If your Medicare Advantage plan does not include a kidney transplant specialist, you currently have time to change your plan. Between January 1 and March 31, you can switch Medicare Advantage plans. However, if it’s past March 31, you will have to wait until the Annual Election Period starting October 15. 

For people with Original Medicare, you have access to all transplant specialists who accept Medicare-assignment. Specifically, Medicare Part B covers doctor services for kidney transplants. What are other medical services covered by Part B?

Medicare Part B Kidney Transplant Service

In addition to doctor services during kidney transplant surgery, Part B covers care before and after surgery. Furthermore, Part B covers doctor services for your kidney donor. You may also be eligible for transplant drugs.

Kidney Transplant Drugs

Kidney transplant drugs are immunosuppressants that help prevent rejection of your new kidney. Furthermore, you will need to take these drugs for the rest of your life. If you are not age 65 but were eligible for Medicare because of an End-Stage Renal Disease (ESRD), please do the following:

  • Enroll in Part A before your kidney transplant
  • Have your kidney transplant surgery at a Medicare-approved facility

According to Medicare.gov, Part B will only cover your transplant drugs when you meet the above conditions. Furthermore, ESRD Medicare coverage expires 36 months after the month of your transplant. If you happen to turn 65 during these 36 months, please enroll in Medicare again to avoid losing coverage. Moreover, if you were eligible for Medicare because you were 65 before you got ESRD, your transplant drug coverage has no time limit. 

Kidney Transplant Drug pharmaist hands over prescription bottle

Now that you know the hospital (Part A) and medical (Part B) services covered by Medicare, what do these services cost?

Medicare Kidney Transplant Costs

According to an NPR.org article, the costs of kidney and related care costs about $100,000 per patient. Furthermore, people who lost Medicare coverage after 36 months bear the monthly cost of transplant drugs. If such a person loses their health insurance, these drug costs thousands per month! 

However, if you have Medicare, Part B pays for your transplant drugs, and you pay the Part B premium. If you take other prescriptions, your Medicare Part D or Medicare Advantage plan pays these costs. Furthermore, most drug plans charge you a monthly fee. So Medicare Part B pays for your kidney transplant medical costs, do you pay any donor costs?

Kidney Donor Costs

Medicare pays for all your kidney donor costs. Thus, neither you nor the donor pays any deductible, coinsurance, or other costs. However, you pay your share of hospital and medical costs.

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Donating a healthy kidney is FREE! Learn more about donating your kidney. You can save a life!

Your Kidney Transplant Costs

Happy african american senior couple
ESRD prevalence is 3.7 times greater in African Americans.

When you get your kidney transplant surgery in a hospital, you pay the Part A deductible $1484 in 2021. However, you do not pay hospital coinsurance as long as your stay is 60 days or less. Furthermore, you can receive up to 20 days in a skilled nursing facility at no cost.

For Part B medical services, you pay the Part B deductible $203 in 2021 kideand 20% coinsurance costs. However, you do not pay for Medicare-approved laboratory tests. If a hospital can not procure blood from a blood bank, you pay for the first three blood units.

If you have a Medicare Advantage plan, what you pay may be different.

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Does Medicare cover hearing aids - Audiologist fits hearing aid for senior man

Does Medicare cover hearing aids?

Does Medicare cover hearing aids - Audiologist fits hearing aid for senior man
Audiologist fits hearing aid for senior man.

Medicare Advantage (MA) plans may cover hearing aids and other benefits not available in Original Medicare. However, Medicare Part B does cover diagnostic hearing test and balance exams. After you pay a $203 Part B deductible in 2021, Medicare covers 80% of your hearing and balance test. (Medicare.gov

Estimated reading time: 3 minutes

Before Medicare Advantage covers your hearing aids, you must first have your hearing tested. So who can order your hearing test?

Medicare Hearing Test Coverage

Medicare will only cover your hearing test if ordered by your doctor or other health care provider. Other than your doctor, the following non-physician practitioners can order your hearing test: (asha.org)

  • Nurse practitioner
  • Clinical nurse specialist
  • Physicians’ assistant

Why would a health care provider order a diagnostic hearing test?

Reasons for Diagnostic Hearing Test

Due to a recent illness or injury, you may suffer hearing loss. Please tell a health care provider if you have difficulty hearing. During your healthcare appointment, a practitioner may observe a communication problem and order a hearing test. 

Audiologist administers hearing test for a senior woman
Audiologist gives hearing test to senior woman

For example, the results of your hearing test may demonstrate you can hear just fine. This outcome may lead to another diagnosis, cognitive impairment such as Alzheimer’s disease.  

Medicare Advantage with Hearing Aid Coverage

Senior Woman Wearing Hearing Aid
Senior woman wearing a hearing aid

If you have Medicare Advantage (MA) plan that does not include hearing aid coverage, you can switch to a MA Plan that does cover hearing aids. You can switch to a different MA Plan during MA Open Enrollment between January 1 and March 31. After March 31, you may be able to make MA Plan changes by qualifying for a Special Election Period. Otherwise, you will have to wait until Annual Election Period between October 15 and December 7.

Now that you know when you can change or enroll MA Plans, what do hearing aids costs? Furthermore, how much could hearing aid coverage save you?

Hearing Aid Costs

According to Miracle-Ear, “the average cost of a hearing aid is $1,000 to $4,000.” However, the real cost of hearing impairment is miscommunication with people and the environment. For example, not hearing an approaching vehicle could cost your life. Thus, the actual price of not using hearing aids could be injury or death. 

When it comes to improving quality of life and preventing accidental death, the value of hearing aids is much higher than the costs. However, with a Medicare Advantage Plan that covers hearing aids, your out-of-pocket costs will be much less. An MA Plan with hearing aid coverage could save you thousands!

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Medicare Advantage Benefits

Medicare Advantage (MA) plans may include benefits not available in Original Medicare or Medigap Plans. You can get the following exclusive benefits in an MA Plan:

Estimated reading time: 4 minutes

Find out when you can change your MA Plan to get these benefits.

Medicare Advantage Benefits senior man on computer and mobile phone
Senior man discovers Medicare Advantage benefits.

Changing Your MA Plan

Senior considers HMO vs PPO
Senior man considers HMO vs PPO advantage plans.

If you want different benefits in your MA Plan, you can switch your plan from January 1 to March 31 during MA Open Enrollment 2021. After this, you can make changes to your Medicare Advantage Plan during the Annual Election Period. However, outside these Open Enrollment Periods, you could qualify for a Special Enrollment Period. Discover the different Medicare Advantage benefits and costs between HMO and PPO Plans.

Medicare Advantage Dental Plans

Medicare Advantage Benefits dental coverage senior woman smiling

Medicare Advantage Plans may include routine dental care. For example, your dental plan may cover regular teeth cleanings and dental exams. Read about Dental Plans for Seniors, and discover the importance of regular dental checkups. Furthermore, find out how dental coverage can help you avoid oral cancer and gum disease.

In addition to dental coverage, your MA Plan may also include a fitness program.

Medicare Advantage Fitness Program

Senior couple exercising in gym
Discover why you need resistance training while dieting

People aged 65 or older can enroll in an MA plan that includes the Silver Sneakers’ fitness program. Members of Silver Sneakers have access to over 16,000 fitness locations across the United States. Discover the benefits of joining Silver Sneakers.

However, if you have MA Plan from UnitedHealthcare, you can join their fitness program called Renew Active. This program offers members “thousands of workout videos with Fitbit Premium content.” Furthermore, you get an “online brain health program with exclusive content from AARP Staying Sharp.” 

Medicare Advantage Hearing Benefits

senior man hearing test
Find a MA Plan that includes hearing aids

Medicare Advantage Plans may provide hearing benefits. For example, Aetna Medicare Plans cover an annual routine hearing exam and hearing aid fitting. Senior Healthcare Direct can help you find a Medicare Advantage plan with hearing benefits. Call 1-855-368-4717 or find your MA Plan.

Read the article Does Medicare cover hearing aids and discover how much an MA Plan could save you.

Medicare Advantage Transportation Benefits

Medicare Advantage Transportation Benefits driver helps senior woman out of car

Medicare Advantage Plans may provide transportation to your health care provider. For example, the Aetna Access2Care service gets you there and back. Aetna’s transportation benefit provides non-emergency transport, 24 one-way trips up to 60 miles per trip at no extra cost.

Furthermore, some MA plans may cover trips to your fitness center. Moreover, your Lyft or Uber trips to health care providers may also be covered. 

MA Vision Benefits

Original Medicare does cover diabetes eye care or glaucoma. However, MA plans may cover vision benefits, such as the cost of eyeglasses. For example, UnitedHealthcare MA plans offer vision benefits that may include:

  • Corrective glasses lenses
  • Frames
  • Contact lenses

Call Senior Healthcare Direct at 1-855-368-4717 to shop Medicare Advantage Plans.

Senior man eye exam for new glasses
Some MA Plans cover the cost of corrective eyeglasses

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Medicare Advantage Open Enrollment 2021

Change Your Medicare Advantage Plan

Medicare Advantage Open Enrollment is between January 1 and March 31, 2021. During this period, you can make the following changes:

  • Switch to a different Medicare Advantage Plan with or without drug coverage
  • Disenroll from Medicare Advantage and return to Original Medicare and join a Part D drug plan

Estimated reading time: 3 minutes

Senior Healthcare Direct can help you find the right Medicare Advantage Plan. We can help you find a plan that includes your doctors and medications. For example, you can change your Medicare Advantage Plan and keep your doctors. 

Find Medicare Advantage Plan happy senior couple at home

Senior Healthcare Direct can help you find the right Part D Drug Plan. We can help you find a drug plan that covers your specific list of prescriptions. Furthermore, you can compare a list of available drug plans and choose the most cost-effective Part D plan. 

After March 31, 2021, you may be able to make Medicare plan changes by qualifying for a Special Election Period.

Medicare Advantage Plan Changes

During the Medicare Advantage Open Enrollment 2021 Period, you must be in a Medicare Advantage Plan to make a change. If you currently have Original Medicare, you cannot change to a Medicare Advantage Plan during this period. Furthermore, you cannot join a Medicare Part D Plan.

However, if you have a Medicare Advantage Plan, you can return to Original Medicare. Then you will have the option of joining a Medicare Part D Plan. Moreover, you will only have the option of changing your Medicare Advantage Plan until March 31, 2021. (Medicare.gov)

Medicare Advantage Open Enrollment 2021 - Senior couple overweight walking in woods

Find the Right Medicare Advantage Plan

The right Medicare Advantage Plan provides you with the following benefits:

  • Costs less
  • Covers your drugs
  • Allows you to go to the providers you want, such as your doctors and pharmacy
  • Offers exclusive benefits that Original Medicare does not cover, like dental, fitness program, hearing, transportation, and vision.

Senior Healthcare Direct can help you find the right Medicare Advantage Plan. Click the button below.

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4 parts of medicare

Medicare Parts coverage and cost in 2021

What do Medicare Parts cover and cost in 2021?

There are 4 parts of Medicare: Part A, Part B, Part C, and Part D.

  • Part A covers inpatient hospital services.
  • Part B covers outpatient medical services.
  • Part C is Medicare Advantage plan offered by private companies approved by Medicare.
  • Part D provides prescription drug coverage to lower the cost you pay for medications.

Estimated reading time: 9 minutes

Before you receive inpatient hospital benefits, you must first pay Part A deductible of $1484 in 2021. However, you can avoid paying this cost by having a Medicare Supplement plan.

Embed or download 4 Parts of Medicare infographic

What does Medicare Part A cover and cost in 2021?

According to Medicare.gov, Part A covers the following:

  • Inpatient hospital care
  • Skilled Nursing Facility care
  • Long-term Care Hospitals
Medicare Part A - Hospital

Inpatient Hospitals Coverage and Cost in 2021

The first 60 days of inpatient care is covered by Medicare Part A. In other words, you pay $0 coinsurance for each 60 day benefit period. For example, you can be a hospital inpatient multiple times per year and each hospital stay will cost you nothing so long as each stay is 60 days or less. However, hospital stays between 61 days and 90 days will cost you $371 coinsurance per day in 2021.

Skilled Nursing Facility

Skilled Nursing Facility Coverage and Cost in 2021

Medicare Part A also covers 20 days of care in a Skilled Nursing Facility (SNF). Specifically, you pay $0 coinsurance for each 20 day benefit period. Some of the benefits of SNF include physical therapy, meals, and dietary counseling. Therefore, you can get short-term skilled nursing care multiple times per year for no cost so long as each stay is 20 days or less. However, SNF stays between 21 days and 100 days will cost you $185.50 per day in 2021.

Long-term Care Hospital Coverage and Cost in 2021

Medicare Part A covers the first 60 days in a Long-term Care Hospital (LTCH). In particular, the cost of LTCH is $0 for each 60 day benefit period under the following conditions.

  • You are transferred to a LTCH directly from an acute care hospital.
  • You are admitted to a LTCH within 60 days of being discharged from a hospital.

If the above conditions do not apply, then you must pay Part A $1484 deductible in 2021 before Medicare will pay anything. Furthermore, LTCH stays from 61 days to 90 days will cost you $371 coinsurance per day in 2021.

Medicare Part A - Long-Term Hospital Care

What does Medicare Part B cover and Cost in 2021?

Medicare Part B covers the following services:

  • Medical outpatient services for stays at any hospital or medical facility for less than 24 hours. For example, a stay that occurs overnight but for less than 24 hours is outpatient service.
  • Preventive services to prevent illness such as seasonal flu-shot and annual wellness visits.
first aid kit

Medicare Outpatient Coverage and Cost in 2021

Original Medicare covers 80% of medically necessary services and supplies. These Part B medical services include:

Before Medicare pays for these medical services and supplies, you must first pay Part B deductible of $203 in 2021. Furthermore, you are responsible to pay the 20% that Medicare does not cover. However, Medicare Supplement Plan C and Plan F pay Part B deductible and your 20% coinsurance.

Medicare Preventive Coverage and Cost

Medicare preventive services cover screening tests that help detect health conditions at early stages when treatment is most effective. In the tables below, we list 31 preventive tests covered by Medicare Part B. 

Medicare Part B preventive screening table 1
Click to view larger table size
Medicare Part B preventive screening table 2
Click to view larger table size

In the above tables, 71% of these screening tests are free after you pay the $203 Part B deductible. Furthermore, 19% of tests require payment of Part B deductible and 20% coinsurance. Finally, 10% of tests you pay absolutely nothing: neither Part B deductible nor 20% coinsurance. These preventive screening tests are completely FREE:

  • Nutrition Therapy Service – you pay nothing if you have diabetes or kidney disease.
  • “Welcome to Medicare” preventive visit – you pay nothing as long as the doctor does not perform additional tests or services.
  • Yearly Wellness Visit – is free every 12 months as long as the doctor does not perform additional tests or services.

To receive Part B coverage you need to pay a monthly premium. In 2021, the standard premium for Part B is $148.50.

What does Medicare Part C cover and cost in 2021?

Part C Medicare Advantage network
MA plans have a network of doctors, hospitals, and other medical services.

Medicare Part C is an alternative to Original Medicare and covers Part A (Hospital Insurance) and Part B (Medical Insurance). Part C is also known as Medicare Advantage (MA) Plan.

Medicare Advantage (MA) Coverage

MA plans often include Medicare Part D prescription drug coverage. Moreover, many MA plans include extra benefits not covered by Original Medicare. For example, MA plans may include dental, vision, and hearing. Some MA plans even include gym memberships such as Silver Sneakers! MA plans are offered through a network of healthcare providers HMO or PPO.

Medicare Advantage (MA) Costs

To enroll in Medicare Advantage Plan (Part C) you must first be enrolled in Part A and Part B. Most Seniors pay no premium for Part A. However, you will have to pay Part B monthly premiums. In 2021, the standard premium for Part B is $148.50. Furthermore, you will need to pay a monthly Part C premium. According to The Kaiser Family Foundation, the average Medicare Advantage Plan premium is $36 in 2020.

When you add standard Part B and average MA premiums, the total monthly cost is $180.66 in 2020. Conversely, Original Medicare Part B and Part D premiums may only cost $177.34 in 2020. However, you may be thrilled to get a gym membership for only a few extra dollars per month!

You can choose a lower premium MA plan. As a result, you may be excited to pay less every month. However, these MA plans will have higher deductibles, copays, and larger out-of-pocket limits. Consequently, the cost to use your health insurance will be much higher. You can avoid these excessive costs by choosing an MA premium of $40 or more.

What does Medicare Part D cover and cost in 2021?

 Part D drug plan
Part D drug plans save you money

Part D saves you money on prescription drugs. Specifically, it reduces your cost for brand-name and generic drugs. For example, rather than paying the full retail price for medications, you only pay small copayments with Part D. To join a Part D drug plan, you must be enrollment in certain parts of Medicare.

How to Join a Drug Plan

You must have either Part A or Part B to join a stand-alone Part D drug plan with Original Medicare. However, you must have both Part A and Part B to join a Medicare Advantage plan.

Part D Costs for Original Medicare and MA Plans

To enroll in Part D with Original Medicare you need to have either Part A or Part B. However, most people have both Part A and Part B coverage. Since private health insurance companies such as Aetna, Mutual of Omaha, and AARP provide drug coverage, the price you pay will vary.

Part D drug costs in 2021 

All Part D drug plans have a monthly Part D premium. This amount will depend on the income reported on your 2019 tax return. Some Part D plans have an annual deductible which can not be more than $445 in 2021. However, other drug plans may have little or no deductible. 

After the out-of-pocket deductible, you pay either a copay or coinsurance for each prescription drug. For example, you pay less for drugs in tier 1 and more for drug in tier 2. Discover the differences in Medicare Part D tier costs. Furthermore, after you and your drug plan spend a certain amount, you enter a coverage gap called the donut hole.

Donut Hole Costs in 2021

In 2021, you will enter the donut hole and pay 25% coinsurance for both brand-name and generic drugs when your drug plan spends $4,130. After total out-of-pocket drug costs are $6,550 in 2021, you exit the donut hole. Learn more about the 4 stages of drug coverage and costs in 2021.

Want More Help with Medicare Parts?

You can speak with a licensed agent at 1-855-368-4717 and get more help with the 4 parts of Medicare: A, B, C, and D. Our team is very experienced at explaining Medicare parts and how they work. 

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Medicare 2021 October Stories

Medicare Stories

Medicare stories published in October 2020 about Medicare changes in 2021.

Senior considers HMO vs PPO

HMO vs PPO: Which is better for you?

HMO vs PPO: Which Plan is Right for You?

Senior considers HMO vs PPO

This article compares HMO vs PPO to help you determine which Medicare Advantage Plan is right for you. Differences between Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) include referrals, coverage, cost, and network size.

Differences between HMO and PPO

HMO vs PPO Chart

The chart above shows you the benefit and cost differences between HMO vs PPO. The green values are positive, and the red values are negative. For example, HMO plans have lower deductible and premium costs (green). However, PPO plans have a higher deductible and premium costs (red). The first significant difference between HMO and PPO is referrals.

Referral difference

A PPO (Preferred Provider Organization) plan does not require referrals. However, HMO (Health Maintenance Organization) often require referrals. For example, HMO plans require referrals from your primary care physician (PCP) to see a specialist or have a special test done.

However, Medicare.gov says certain services such as annual mammogram screenings do not require a referral.

Coverage differences

A second important difference between PPO and HMO is coverage. With a PPO you can see a doctor outside your network, but it may cost you more. However, an HMO does not provide coverage outside your network.

Thus, you pay all health care costs for out-of-network services with an HMO unless you have an HMO-POS (Point of Service) plan. Moreover, you can get out-of-network HMO coverage for emergency or urgent care.

Cost differences

PPO plans have better coverage and cost more than HMO plans. Some HMO plans may have $0 premium, and HMO-POS plans have a separate deductible. Thus, you pay one deductible for in-network and second deductibles for out-of-network with an HMO-POS plan.

Furthermore, Medicare.gov states an HMO-POS plan will “allow you to get some services out-of-network for a higher copayment or coinsurance.” Senior Healthcare Direct can help you find the most cost-effective HMO and PPO plans. Find plans that include your doctors and medications get your quote.

Find Medicare Advantage Plan happy senior couple at home

Network size 

HMOs have the smallest network of doctors and hospitals. Thus, your choice of medical providers and facilities are more limited with an HMO. On the other hand, PPO plans have larger networks than HMO. 

For example, an HMO network may include a county or part of a county, whereas a PPO network may serve a state or multi-state area. 

Network Size HMO vs PPO
Medicare Underwriting - Advantage vs. Supplement - Happy Seniors

Medicare Advantage vs Medicare Supplement

Compare Advantage Vs Medicare Supplement

The Medicare 2021 chart below compares Medicare Advantage vs Medicare Supplement. This chart shows positive (green), negative (red), and equal value (black). Medicare Supplement works with Original Medicare, so it provides you with nationwide coverage and access to any doctor and hospital without referrals.

However, Medicare Advantage provides you with local (HMO) or regional (PPO) coverage for doctors and hospitals in-network. For example, doctors outside an HMO network are not covered and require referrals. Furthermore, doctors outside of a PPO network are allowed but will cost you more. The 2021 chart below shows you several differences between Medicare Advantage vs Medicare Supplement.

Medicare Advantage vs Medicare Supplement - happy seniors
Medicare 2021 Chart - Advantage vs Supplement infographic
Embed and download Medicare Advantage vs Medicare Supplement Infographic

MedicareBob Video

In this MedicareBob video, Robert Bache “talks about the most important decision” people new to Medicare will make. Should you choose a Medicare Advantage or Medicare Supplement? Watch this video to help determine the right Medicare plan for you. 

Medicare Advantage vs Supplement Cost Differences

Part B Premium

Medicare Advantage and Medicare Supplement require you to have Medicare Part B. There is no Medigap Plan that pays your Medicare Part B premium. However, some Medicare Advantage Plans pay all or part of your Part B premium.

Copays and Coinsurance

Medicare Advantage charges you copays for each doctor visit or medical service. However, Advantage Plans do not charge you coinsurance.

Medicare Supplement Plans have no copays, except plans K (50%), L (75%), and N. You are charged copays for diagnostic tests, hospital outpatient, and ER visits. For Plan N, you pay up to $50 for outpatient emergency room visits and up to $20 for outpatient doctor visits.

Furthermore, Supplement Plans K and L only pay 50% and 75% respectively for Part B, Part A Hospice, and Skilled Nursing Facility coinsurance. In other words, you pay the remaining balance. For example, Medigap Plan K will cover 50% of your outpatient medicare service.

Advantage vs Supplement Plan Premiums

Medicare Advantage Plan premiums will vary based on coverage and the insurance carrier. However, CMS.gov reports, “historically low premiums in Medicare Advantage.” Furthermore, you have more than 1,600 prescription drug plans from which to choose. We can help you find the right Medicare Advantage Plan with our Advantage Plan Finder.

Medicare Supplements pay Part A and Part B coinsurance. For example, Medigap Plan G covers 100% of your hospital and medical services after you pay a $203 Part B deductible in 2021. Plan G is the most comprehensive coverage available for people new to Medicare since 2020. You can shop Medigap Plans by calling Senior Healthcare Direct at 1-855-368-4717 or get your quote.

Medical Underwriting – Advantage vs Supplement

Medicare Underwriting - Advantage vs. Supplement - Happy Seniors
Happy seniors avoid medical underwriting.

Starting in 2021, Medicare Advantage Plans accept all health conditions, including End-Stage Renal Disease (ESRD). Likewise, you can enroll in Medicare Supplement Plan without medical underwriting during your initial Open Enrollment Period (OEP). In other words, there is no medical underwriting when you are first eligible for Medicare, which includes:

  • Three months before you turn 65
  • The month you turn 65
  • Three months after you turn 65

However, anytime after your initial Open Enrollment Period, medical underwriting is required. For example, you switch to a different Medigap Plan after your initial OEP. Discover some of the most common underwriting questions and find out whether or not you can qualify.

Prescription Drugs – Advantage vs Supplement

Medicare Advantage Plans such as HMO and PPO most often include prescription drug coverage. However, Advantage Plans are not required to cover prescription drugs. If your HMO or PPO does not provide drug coverage and you enroll in a separate Medicare Prescription Drug Plan, you will be disenrolled from your Medicare Advantage Plan.

Medicare Supplement Plans fills in the coinsurance and deductible coverage gaps of Original Medicare, which does not cover prescription drugs. To get drug coverage, you need to enroll in a separate Part D drug plan. Senior Healthcare Direct can help you find the right drug plan that includes all your prescriptions.

Max Out-of-Pocket Limits – Advantage vs Supplement

Forbes reports Medicare Advantage maximum out-of-pocket (MOOP) limits will increase to $7,550 in 2021. In other words, your max out-of-pocket cost will be $850 more for in-network services in 2021. Once you reach this MOOP limit, your Medicare Advantage plan will cover all costs until the end of the year.

All Medicare Supplement Plans cover most or all of your out-of-pocket costs except plans K and L. Thus, CMS.gov put the following out-of-pocket 2021 limits on plans K and L.

  • $6,220 for Plan K ($740 increase from 2020)
  • $3,110 for Plan L ($170 increase from 2020)

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