Medicare Part C, commonly called Medicare Advantage, is a bundled alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans are required to cover everything that Medicare Part A (hospital insurance) and Part B (medical insurance) cover, and most plans also include prescription drug coverage and extras like dental, vision, and hearing benefits that Original Medicare does not provide.
Everything in Original Medicare, Plus More
At its core, a Medicare Advantage plan must cover all the same services you would get through Original Medicare. That includes hospital stays, skilled nursing facility care, home health services, doctor visits, lab tests, preventive screenings, outpatient surgery, durable medical equipment, and mental health services. If Original Medicare covers it, your Part C plan covers it too. The difference is in how you access that care: instead of going to any Medicare-accepting provider nationwide, you typically work within a plan’s provider network and may need referrals or prior authorization for certain services.
Most Medicare Advantage plans go beyond these baseline requirements. They bundle in Part D prescription drug coverage, creating what’s known as an MA-PD plan. If your plan includes drug coverage, you cannot also enroll in a separate standalone Part D plan. Some plans, particularly certain Private Fee-for-Service (PFFS) plans, do not include drug benefits. Members of those PFFS plans can enroll in a separate Part D plan, but members of other types of Medicare Advantage plans without drug coverage cannot. Those plans only make sense if you have drug coverage from another source, such as the VA.
Dental, Vision, Hearing, and Fitness Benefits
This is where Medicare Advantage stands apart most visibly from Original Medicare, which offers very limited dental, vision, and hearing coverage. According to KFF’s analysis of 2025 plans, more than 99% of individual Medicare Advantage enrollees have access to eye exams or glasses, 98% to dental care, 95% to hearing exams or hearing aids, and 94% to a fitness benefit.
The catch is that the depth of these benefits varies significantly from plan to plan. A dental benefit might cover only preventive services like cleanings and X-rays, or it might extend to crowns, dentures, and root canals. Before choosing a plan based on these extras, check what’s actually included, what the copays look like, and whether there’s an annual cap on coverage.
Benefits for People With Chronic Conditions
Since 2019, Medicare Advantage plans have been allowed to offer a special category of supplemental benefits specifically for enrollees with chronic illnesses. These are known as Special Supplemental Benefits for the Chronically Ill (SSBCI), and they address needs that go well beyond traditional medical care.
These benefits can include home-delivered meals on an ongoing basis, transportation for non-medical needs like grocery shopping or banking, and structural home modifications such as widening doorways, installing permanent ramps, or replacing doorknobs with easier-to-use hardware. The goal is to address the day-to-day barriers that make it harder for people with chronic conditions to stay healthy and independent.
Not every plan offers these benefits, and eligibility depends on having a qualifying chronic condition. Special Needs Plans (SNPs), which are designed specifically for people with chronic illnesses, low incomes, or those living in institutions, tend to offer these benefits at much higher rates. For example, 82% of SNP enrollees have access to meal benefits compared to 70% in standard individual plans, and 80% have transportation benefits compared to just 28%.
Telehealth and Virtual Care
Medicare Advantage plans often provide broader telehealth coverage than Original Medicare. While Original Medicare covers telehealth services like depression screenings, diabetes self-management training, speech therapy, cardiac rehabilitation, and cognitive assessments, Part C plans may let you access these and other services from home regardless of where you live. That flexibility can be a meaningful advantage for people in rural areas or those with mobility limitations. Plans may cover video visits, phone-only consultations, e-visits through a patient portal, and brief virtual check-ins lasting 10 minutes or less.
HMO vs. PPO: How Plan Type Affects Your Coverage
The type of Medicare Advantage plan you choose shapes how you use your benefits day to day. The two most common types are HMOs and PPOs, and they work quite differently.
With an HMO, you generally must see in-network providers and stay within your plan’s service area (except for emergencies or urgent care). You’ll typically need a referral from your primary care doctor before seeing a specialist. The trade-off for these restrictions is usually lower premiums and out-of-pocket costs.
PPOs give you more flexibility. You can see any provider, including out-of-network doctors, though you’ll pay more for going outside the network. You don’t need referrals for specialists, and you can visit doctors anywhere in the country, though again at higher cost when they’re out of network. If having a wider choice of providers matters to you, a PPO may be worth the higher cost-sharing.
What Part C Does Not Cover
There is one notable gap. If you elect hospice care, that coverage comes through Original Medicare Part A, not through your Medicare Advantage plan. To qualify, your doctor must certify a life expectancy of six months or less, and you must agree to receive comfort care rather than curative treatment. While you’re receiving hospice care, your Medicare Advantage plan still covers services unrelated to your terminal illness.
Medicare Advantage plans also cannot cover anything that Original Medicare itself excludes, such as long-term custodial care, most cosmetic surgery, or routine care received outside the United States.
Financial Protections Built Into Part C
One of the most significant structural advantages of Medicare Advantage over Original Medicare is the annual out-of-pocket maximum. Original Medicare has no cap on what you can spend in a given year. If you have a major hospitalization or ongoing treatment, your 20% coinsurance on Part B services can add up without limit. Medicare Advantage plans are required by law to set a maximum annual out-of-pocket limit for in-network services. Once you hit that cap, the plan pays 100% of covered services for the rest of the year.
Many plans also charge $0 monthly premiums beyond the Part B premium you already pay, though lower-premium plans may have higher copays and deductibles. The financial math depends on how much care you use, which providers you want to see, and whether the supplemental benefits (dental, vision, hearing) save you enough to offset any network restrictions.