Medicare Advantage Plans, also known as Part C, are required to cover emergency care and hospitalization similarly to Original Medicare, with additional benefits and considerations based on the specific plan. Here’s how these plans handle emergency care and hospitalization:
Emergency Care
- Coverage: Medicare Advantage plans must cover emergency care anywhere in the United States, regardless of whether the provider is in-network or out-of-network.
- Cost Sharing: You might have copayments or coinsurance for emergency services. These costs can vary based on the plan, but they are often lower than those for non-emergency out-of-network care.
- Prior Authorization: No prior authorization is needed for emergency care. You can go directly to the nearest emergency room if you have a medical emergency.
- Follow-Up Care: While emergency care is covered, follow-up care might need to be within the plan’s network to avoid higher out-of-pocket costs. Always check with your plan for specific follow-up care guidelines.
Hospitalization
- Inpatient Hospital Services: Medicare Advantage plans cover all inpatient hospital services that Original Medicare covers. This includes semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
- Cost Sharing: You may have copayments or coinsurance for hospital stays, and these costs can vary by plan. Some plans may have a fixed copayment per day for a certain number of days.
- Network Restrictions: For planned hospitalizations, you typically need to use hospitals within your plan’s network to receive the lowest cost. However, if you’re admitted to a hospital for emergency care, the plan will cover the costs even if the hospital is out-of-network.
- Prior Authorization: Many Medicare Advantage plans require prior authorization for non-emergency hospital stays. This means your doctor must get approval from the plan before you are admitted to avoid higher costs or denial of coverage.
Additional Benefits
- Prescription Drugs: Many Medicare Advantage plans include Part D prescription drug coverage, which covers medications needed during and after hospitalization.
- Extra Services: Some plans offer additional services like transportation to medical appointments, meal delivery post-discharge, and home health care services, which can be beneficial during recovery.