Are covered benefits and cost-sharing requirements under Medicare Advantage plans the same thing?

Covered benefits and cost-sharing for Medicare Advantage plans are two very different things. Covered benefits are a list of specific services, tests, etc., that are covered by your Medicare Advantage plan. All Medicare Advantage plans must cover at a minimum the same benefits provided by Original Medicare Parts A & B. They also frequently include supplemental benefits. These can include things like Dental, Vision, Hearing, Fitness memberships, over-the-counter drug benefits, transportation, and more. Every Medicare Advantage plan is required to provide you with a Summary of Benefits that outlines all of the covered benefits under the Medicare Advantage plan.

Cost-sharing is a financial aspect of your Medicare Advantage plan and includes deductibles, copays, and coinsurance. These out-of-pocket costs are then applied to the various covered benefits provided by your plan. Each covered benefit has an associated deductible, copay, or coinsurance applied to it. Some services like preventative service may have a $0 cost-sharing amount associated with that particular benefit. You plan Summary of Benefits will also include the cost-sharing that is applied to each covered benefit.

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