If you’re exploring Medicare Advantage plans with dental benefits, it’s important to understand what’s covered—and what’s not—before you book that next cleaning.
Most Medicare Advantage plans that include dental coverage offer full benefits for preventive care, including:
Routine cleanings
Oral exams
X-rays
These services are often covered at 100%, especially if you visit a provider within your plan’s network. While some PPO and HMO plans allow you to see any licensed dentist, you’ll typically pay less out-of-pocket by choosing an in-network provider.
What About More Extensive Dental Work?
Coverage for restorative procedures—like fillings, extractions, or crowns—varies significantly by plan. Some may cover a portion of the cost, while others might require higher copays or coinsurance. Always review your plan’s summary of benefits to know exactly what to expect.
Coverage Limits You Should Know
Keep in mind, dental coverage through Medicare Advantage may come with:
Annual limits on preventive services
Caps on coverage for major procedures
Benefit maximums (i.e., the total your plan will pay for dental care each year)
These maximums can range widely, from as little as $10 to as much as $6,000, depending on the plan. It’s crucial to check with your provider so you’re not caught off guard.
Need Help Choosing the Right Dental Plan?
You don’t have to navigate this alone. Health Plans of America connects you with licensed Medicare specialists who can walk you through your options and help you find coverage that fits your needs and budget.
Get started today and take the guesswork out of dental coverage.
When was the last time you reviewed what your healthcare plan really offers? Most people focus on the basics—doctor visits, prescriptions, and emergency care—but many plans come with additional perks that are often underutilized or completely overlooked.
Here are a few valuable benefits that might be included in your health plan, just waiting to be used:
Health Coaching
Whether you’re working on lowering your cholesterol, managing a chronic condition like asthma or diabetes, or simply trying to lose weight, health coaching can be a game-changer. These one-on-one sessions with wellness professionals provide personalized support to help you stay on track and reach your goals.
24/7 Nurse Hotline
Health concerns don’t follow a 9-to-5 schedule. That’s why many providers offer around-the-clock access to licensed nurses and medical professionals. Whether you’re wondering if your symptoms warrant a trip to urgent care or need advice on managing a minor illness, help is just a phone call away.
Cost Estimator Tools
Healthcare costs can vary widely, even within the same city. Many insurers provide online cost calculators to help you compare prices for procedures, tests, and visits. This tool empowers you to budget more effectively and avoid surprises when the bill arrives.
Diet & Weight Management Programs
Healthy living isn’t just about cutting calories. Many plans offer access to nutritionists, guided meal planning, and long-term lifestyle programs to support your overall well-being. These programs can make it easier to adopt habits that stick, without having to figure it all out on your own.
Take Advantage of What You’re Already Paying For
If any of these services sound like something you’d benefit from, now is a great time to contact your healthcare provider and ask what’s included in your current plan. You might be surprised by what’s available to you at little or no extra cost.
Whether you’re evaluating plans for the first time or considering switching providers, Health Plans of America is here to help you navigate your options and make the most of your coverage. Don’t leave valuable benefits on the table—get informed, get covered, and get the care you deserve.
If you’re currently enrolled in Medicare or considering signing up, it’s essential to understand exactly what’s covered under your plan—and just as importantly, what isn’t. While Medicare provides comprehensive coverage for many healthcare needs, there are some health-related services that it doesn’t cover. Being aware of these exclusions can help you make more informed decisions about your care and ensure you’re not caught off guard when the bills come.
Here are some of the most common services that Medicare does not cover:
1. Routine Foot Care
Medicare typically does not cover routine foot care, such as the treatment of corns, calluses, or toenail care. While this may come as a surprise to some, it’s important to note that treatment for foot injuries or certain medical conditions related to the feet, such as diabetes, iscovered. If you have specific foot health concerns, you may want to explore other insurance options or consult with your doctor about additional coverage for preventative care.
2. Cosmetic Surgery
Unless cosmetic surgery is medically necessary to repair or improve the function of a malformed body part or following an injury, Medicare will not cover elective cosmetic procedures. This means surgeries like facelifts, breast augmentations, or tummy tucks—intended purely for aesthetic purposes—will not be covered by your Medicare plan. However, if the surgery is needed for reconstructive purposes after an accident or illness, Medicare may cover part of the costs.
3. Orthopedic Shoes
While orthopedic shoes can be beneficial for individuals with specific medical conditions, Medicare coverage is limited. Medicare only covers orthopedic shoes if they are part of a leg brace. This means that unless your shoes are prescribed as part of a necessary medical device or treatment plan, you’ll likely need to pay out of pocket for these types of shoes or inserts.
4. Dental and Vision Care
Medicare generally doesn’t cover routine dental care, including cleanings, fillings, dentures, or tooth extractions. Additionally, most vision care services, such as eye exams for glasses or contact lenses, are not covered under Original Medicare. However, Medicare Part B may cover some vision-related services if you have certain medical conditions, such as cataracts or glaucoma.
5. Hearing Aids and Exams
Similarly, routine hearing exams and hearing aids are not covered by Medicare. If you need hearing aids, you will likely have to cover the cost yourself, or look into additional insurance options that may offer coverage for hearing-related services.
The Silver Lining: What Medicare Does Cover
While Medicare doesn’t cover every health service, it provides extensive coverage for a wide range of medical needs, especially those related to acute illnesses, hospital stays, doctor visits, and some preventive services. From routine screenings and vaccinations to prescription drugs (under Part D), Medicare ensures that a variety of your health needs are met.
Make Informed Decisions for Your Health Coverage
Before you choose a Medicare plan, it’s crucial to assess your unique health needs and consider any conditions or services you might require that aren’t covered under standard Medicare. Some additional coverage options, such as Medigap or Medicare Advantage, may help fill in the gaps left by Original Medicare.
If you’re still uncertain about which plan is best for you, don’t hesitate to seek professional guidance. At Health Plans of America, we make the process easier by offering you expert information, resources, and access to licensed Medicare specialists who can help guide you through the decision-making process.
Have more questions or need help understanding your options? Connect with a licensed Medicare specialist today and take the first step toward securing the right coverage for your needs.
Navigating the world of health insurance can feel like learning a new language. With all the jargon and unfamiliar terms, it’s easy to get lost in the details. However, understanding a few key terms can make managing your health insurance plan much simpler and help you make better, more informed decisions. Here are five essential health insurance terms that you need to know:
1. Premium
Your premium is the amount you pay monthly to maintain your health insurance coverage. Think of it as your “membership fee” to have access to the insurance plan. However, it’s important to note that paying your premium doesn’t necessarily cover the full cost of your medical services. In fact, it’s just the baseline for having coverage. Depending on your plan, your premium could be a small part of the total amount you pay for healthcare each year.
2. Deductible
The deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts to share the costs. For example, if your deductible is $1,000, you’ll need to pay that amount in full before your insurer kicks in to cover a larger portion of your healthcare costs. But keep in mind, even after you’ve met your deductible, you may still need to pay copayments or coinsurance until you reach your out-of-pocket maximum.
3. Copayment (Copay)
A copayment, often called a copay, is a fixed amount you pay for a specific service or prescription. For instance, you might pay $20 for a doctor’s visit or $10 for a prescription medication. Your insurer typically covers the rest of the cost. Copays often come into play after you’ve met your deductible, and they are one of the ways health insurance companies share costs with you. Copays can vary depending on the service, and some plans have different copays for different types of care (e.g., primary care visits vs. specialist visits).
4. Coinsurance
Coinsurance works similarly to copayments, but instead of a fixed amount, it’s a percentage of the cost. Once you’ve met your deductible, you will be responsible for a percentage of the covered services. For example, if your coinsurance is 20%, and you receive a medical bill for $100, you’ll pay $20, while your insurance covers the remaining $80. Coinsurance continues until you reach your out-of-pocket maximum.
5. Maximum Out-of-Pocket
The maximum out-of-pocket (often called the out-of-pocket limit) is the most you’ll ever have to pay in a year for covered healthcare services. This includes your deductible, copayments, and coinsurance costs. Once you hit this limit, your insurance will cover 100% of your remaining covered medical expenses for the rest of the year. However, remember that your monthly premium doesn’t count toward this limit, so you’ll still need to pay that regularly, regardless of how much you’ve spent on healthcare.
Why These Terms Matter
Understanding these terms is more than just navigating the fine print on your health insurance plan—it’s about making smarter, more informed decisions regarding your healthcare. When you know how these elements work together, you can plan better, budget for expenses, and avoid surprises when it’s time to pay your bills. Whether you’re selecting a new plan or managing your current one, these terms will be critical to understanding your costs and coverage.
Simplify Your Health Insurance Search
At Health Plans of America, we make finding the right health insurance plan hassle-free. Our licensed insurance agents are here to help you navigate through the complex world of health coverage, ensuring you get a plan that works for both your health needs and your budget. Don’t let confusing insurance terminology hold you back—get in touch with us today and take the next step toward securing the coverage you deserve.
HMO, PPO, EPO: Breaking Down Health Insurance Plans Without the Headache
Navigating health insurance can feel like learning a whole new language—HMO, PPO, EPO, copay, deductible… it’s enough to make your head spin.
But don’t worry—we’re here to simplify the jargon and help you understand the most important details so you can choose the best health insurance plan for your needs (and your budget).
Let’s break it down:
HMO: Health Maintenance Organization
Looking for a budget-friendly plan with predictable costs? An HMO might be for you.
Lower premiums and fixed copays
Requires you to choose a Primary Care Physician (PCP)
Referrals needed to see specialists
Only covers in-network providers
This plan works best if you’re comfortable sticking with one doctor and staying within a defined provider network. Just make sure you choose a PCP you trust—they’ll be your go-to for all things healthcare-related.
PPO: Preferred Provider Organization
If flexibility matters more to you, a PPO plan offers more freedom—at a higher price.
Higher premiums than an HMO
No referrals needed to see specialists
Coverage for both in-network and out-of-network care
Lower out-of-pocket costs when you stay in-network
A PPO is a solid choice if you regularly visit healthcare providers or want the ability to see specialists without jumping through hoops.
EPO: Exclusive Provider Organization
EPOs are something of a middle ground between HMOs and PPOs.
Only covers in-network care
Typically no referrals required
Larger network than an HMO
Premiums vary depending on the plan
This plan is great if you’re okay staying in-network but want a wider range of doctors to choose from—and fewer restrictions when seeing specialists.
Final Thoughts
Understanding the differences between HMO, PPO, and EPO plans can make choosing the right health insurance much easier. It all comes down to your healthcare needs, preferences, and budget.
At Health Plan Market, we make it simple to explore your options. Our licensed insurance agents are here to help you find a plan that fits your life—and your wallet.
Ready to get started? Let us guide you to the coverage that works for you.
Have you heard of Medigap and wondered how it differs from a Medicare Advantage plan? It can be confusing to navigate the world of Medicare options, but we’re here to break down the key differences to help you make an informed decision.
Medigap vs. Medicare Advantage: Key Differences
Premium Costs: Medigap typically has higher premiums compared to Medicare Advantage, which often offers lower monthly costs.
Out-of-Pocket Expenses: With Medigap, you’ll generally pay fewer out-of-pocket costs for medical care. On the other hand, Medicare Advantage tends to have higher out-of-pocket expenses.
Where You Can Receive Care: Medigap is accepted nationwide, so you can receive care anywhere in the U.S. Medicare Advantage, however, is typically limited to specific regions and states.
Provider Network: Medigap doesn’t require you to stay within a specific network of providers, while Medicare Advantage plans do, meaning you’ll need to use in-network doctors and hospitals for the best coverage.
Prescription Drug Coverage: Medigap doesn’t include prescription drug coverage (Part D), so you’d need to enroll separately for that. Medicare Advantage, however, usually includes prescription drug coverage as part of the plan.
Navigating Medicare options can be overwhelming, but you don’t have to do it alone. If you have more questions or need guidance, Health Plans of America is here to help. Their team of licensed insurance professionals is ready to provide you with personalized information and resources, making the decision process easier. Connect with a licensed Medicare specialist near you today!
