1 Freed M, et al. (Nov. 15, 2023). Medicare Advantage 2024 Spotlight: First Look. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-2024-spotlight-first-look.
Part C
What Benefits Can Medicare Advantage Plans Cover?
- March 21, 2024
- Reviewed by John Krahnert
Medicare Advantage plans provide the same coverage as Original Medicare. Medicare Advantage plans can also cover things like prescription drug coverage, vision, dental and/or wellness program benefits, which Original Medicare does not cover. Plans with one or more of these benefits may not be available where you live, so be sure to compare your local options.
Medicare Advantage (Part C) plans cover Original Medicare benefits
All Medicare Advantage plans include the same standard benefits as Medicare Part A and Part B.
- Medicare Part A benefits include coverage for inpatient hospital stays, hospice care for those with a terminal illness, skilled nursing facility care and some home health care.
- Medicare Part B benefits include coverage for diagnostic services, routine doctor services, outpatient care, medical equipment and other non-emergency medical care.
Medicare Part C plans are required by law to cover all of the above benefits.
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Medicare Advantage plans can offer more benefits
Medicare Advantage plans can cover benefits such as one or more of the following:
- Routine dental care
- Routine vision coverage
- Fitness and/or wellness program memberships, such as SilverSneakers
Individual plan benefits and availability can vary depending on where you live and the type of Part C plan you have. Not all of these benefits will be available with Medicare Advantage plans in all areas.
Medicare Advantage plan benefits can change from year to year, so it's important to check with your plan each year to make sure it is still the best Medicare Advantage plan for your unique needs.
Prescription drug coverage
Medicare Advantage plans can include prescription drug coverage. 89% of 2024 Medicare Advantage plans offer prescription drug coverage, according to the Kaiser Family Foundation.1
Each plan has its own formulary, which is a list of drugs and brand names the plan provider will cover.
In a Medicare formulary, drugs are separated into different tiers.
- Common and less expensive generic drugs are typically grouped into a lower tier.
- Rare, more expensive brand name drugs and specialty drugs are typically grouped into a higher tier.
The coverage for each category of drug may vary from one plan to the next.
Before enrolling, you should review a plan’s formulary to find out if your particular medications are covered.
Can Medicare Advantage plans cover vision benefits?
While Medicare Part B offers some coverage related to vision, it doesn't cover routine eye exams or glasses. Medicare Advantage plans can cover routine vision care, though these benefits may not be available where you live.
Part C plans that include vision coverage can include benefits for services and items such as routine eye exams and allowances for prescription glasses or contact lenses.
99% of 2024 Medicare Advantage plans offer vision benefits, according to the Kaiser Family Foundation.1
Can Medicare Advantage plans cover dental benefits?
Medicare Part B similarly does not typically cover routine dental care services.
Medicare Part C plans can offer dental benefits such as one or more of the following:
- Routine dental exams and checkups
- Teeth cleaning
- Dental X-rays
- Root canals, bridges, crowns and other dental work
- Allowances for dentures
Again, keep in mind that plans with dental benefits may not be available where you live.
97% of 2024 Medicare Advantage plans offer dental benefits, according to the Kaiser Family Foundation.1
Can Medicare Advantage plans cover hearing benefits?
While Original Medicare does not provide any coverage for routine hearing exams or hearing aids, Medicare Advantage plans can offer hearing benefits, though hearing benefits aren’t available with all plans.
Medicare Advantage plans that cover hearing care may offer benefits such as one or more of the following:
- Routine hearing tests and hearing exams
- Allowances for hearing aids
- Hearing aid fittings and maintenance
In 2024, 98% of Medicare Advantage plans offer hearing benefits, according to the Kaiser Family Foundation.1
Can Medicare Advantage plans cover health and wellness programs?
Another benefit that Medicare Part C plans can offer that Original Medicare doesn’t cover is membership to fitness and wellness programs.
Among the most popular of these types of fitness programs is SilverSneakers, which is a fitness program catered to older adults.
SilverSneakers has thousands of participating locations across the U.S. and includes access to exercise classes, outdoor activities, recreational sports leagues, yoga, swimming pools and other gym facilities and much more.
Fitness benefits may not be available with plans in your area. According to the Kaiser Family Foundation, 98% of 2024 Medicare Advantage plans offer fitness benefits.1
How to enroll in Medicare Part C
Enrolling in a Medicare Advantage plan does not mean that you are disenrolling from Original Medicare. In fact, you must enroll in Original Medicare in order to belong to a Medicare Advantage plan.
You will still technically have Original Medicare (and in most cases, you must continue to pay your Medicare Part B premium), but your health insurance coverage will come from your Medicare Advantage plan carrier.
Before you enroll in a particular Medicare Advantage plan, you should carefully review the benefits and the out-of-pocket costs it can help cover.
It’s also important to note that you can only enroll in a Medicare Advantage plan during approved enrollment periods. Current Medicare beneficiaries typically must wait until the fall Medicare Open Enrollment period (Oct. 15 – Dec. 7 each year) to make changes to their plan, unless you qualify for a Special Enrollment Period.
If you already have a Medicare Advantage plan, check with your Medicare Advantage plan provider to see if a particular medical service is covered. If you receive treatment that is not medically necessary and not covered by your Medicare Advantage plan, you may have to pay all of the costs.
To learn more about Medicare Advantage plans and to find plans in your area, call a licensed insurance agent today or compare plans online. We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
