• Medicare is the federal government-administered health insurance system for the elderly and disabled. Medicare beneficiaries have the option to receive their health care benefits either directly through the government or through private health plans called Medicare Advantage. These plans are overseen by the Centers for Medicare & Medicaid Services, which implement the regulations and requirements.
  
  

Basic Medicare Services

• Medicare Advantage plans must offer all services covered under Part A and Part B. This includes inpatient hospital coverage, outpatient doctor services and all related supplies that Medicare would typically cover. This means that a Medicare Advantage plan, for example, must cover at least 90 days in a hospital per year, just like traditional Medicare would. The plan cannot put additional rules or restrictions which would keep beneficiaries from getting the coverage to which they're entitled.
  
  

Additional Services

• According to the Centers for Medicare Advocacy, all Medicare Advantage plans must offer benefits beyond the basic Medicare services. For example, many Medicare Advantage plans offer dental care, vision care and preventive services that traditional Medicare does not cover.
  
  

Emergency Services

• Since most Medicare Advantage plans restrict beneficiaries to a network, Medicare requires Medicare Advantage plans to cover emergency and urgent care if the beneficiary is traveling out of the geographical coverage area and is unable to reasonably return.
  
  

Required Disclosure

• The Centers for Medicare & Medicaid Services requires Medicare Advantage plans to provide beneficiaries with certain information about the plan. The Center for Medicare Advocacy reports that this includes how many doctors participate in the plan, how the beneficiary can access emergency service, out-of-network coverage, restrictions on coverage such as prior authorization, appeals and grievance procedures, any quality assurance mechanisms, customer service data such as the number of grievances and appeals the plan has received, and more. Plans must also tell beneficiaries about whether services are currently available in their coverage area and tell about any cost savings as a result of effective administration.
  
  

Drug Formulary Changes

• If the Medicare Advantage plan is bundled with Part D prescription drug coverage, the plan is required to notify the beneficiary of any drug formulary (the list of drugs the plan covers) changes whenever they are made. This includes any tier changes or the exclusion of any drugs due to recalls.