Medicare Advantage plans cover everything Original Medicare covers, plus most plans bundle in extras like dental, vision, hearing, prescription drugs, and fitness benefits. These plans are sold by private insurers but regulated by the federal government, which means every plan must, at minimum, match the hospital and medical coverage you’d get from Medicare Parts A and B. Where plans differ is in the additional benefits they offer, how much you pay out of pocket, and whether you need to stay within a provider network.
Hospital and Medical Coverage
Every Medicare Advantage plan is required by law to cover the same services as Original Medicare Parts A and B. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care. Part B covers doctor visits, outpatient care, durable medical equipment (wheelchairs, walkers, hospital beds), and preventive services like screenings, vaccines, and annual wellness visits.
The coverage itself is equivalent, but how you pay for it differs. Original Medicare uses standardized deductibles and coinsurance with no cap on what you might spend in a year. Medicare Advantage plans, by contrast, are required to set a maximum out-of-pocket limit. In 2025, that cap can’t exceed $9,350 for in-network services or $14,000 for in-network and out-of-network services combined. Once you hit that limit, the plan pays 100% of covered services for the rest of the year.
Prescription Drug Coverage
Most Medicare Advantage plans include prescription drug coverage (Part D) built right into the plan. These are called MA-PD plans, and they’re now the primary way people with Medicare get drug coverage. Close to 32 million people are enrolled in Medicare Advantage drug plans, making up 58% of all Part D enrollees in 2025.
Each plan maintains a formulary, which is the list of drugs it covers and the cost-sharing tier each drug falls into. Generic medications typically sit on the lowest-cost tiers, while specialty and brand-name drugs cost more. If you take specific medications, it’s worth checking whether they’re on a plan’s formulary before enrolling, since formularies vary significantly between plans.
Dental, Vision, and Hearing Benefits
This is one of the biggest reasons people choose Medicare Advantage over Original Medicare: dental, vision, and hearing coverage that Original Medicare largely doesn’t provide.
As of 2021, 94% of Medicare Advantage enrollees had access to some dental coverage. Most of those (86%) were offered both preventive and more extensive dental benefits. Preventive services like cleanings, exams, and X-rays come with no cost-sharing for about two-thirds of enrollees. More extensive work like fillings, extractions, and root canals typically carries 50% coinsurance. There’s usually an annual dollar cap on dental benefits, averaging around $1,300.
Vision coverage is nearly universal, with 99% of enrollees having access to some vision benefit. Among those, 93% get coverage for both eye exams and eyewear. The catch is that annual dollar limits on vision are tight, averaging just $160. About half of plans limit you to one pair of glasses per year, while nearly as many allow one pair every two years.
Hearing benefits are available to 97% of enrollees. Nearly all of those plans cover both hearing exams and hearing aids, though hearing aid coverage comes with an average dollar limit of $960 and most plans cap you at one set of aids per year.
Fitness and Wellness Programs
Many Medicare Advantage plans include free gym memberships or fitness programs. The most well-known is SilverSneakers, a health and fitness program designed for adults 65 and older. Original Medicare does not cover gym memberships or fitness programs of any kind.
SilverSneakers gives you access to participating gym facilities, including equipment, pools, and walking tracks, along with fitness classes designed for older adults covering cardio, strength training, and yoga. The program also includes a community component called FLEX, which offers instructor-led classes in local parks and recreation centers. Options range from tai chi and barre to line dancing, walking groups, and chair aerobics. Digital resources including home workout videos, nutrition tips, and fall prevention strategies are part of the package as well.
Telehealth Services
Medicare Advantage plans cover telehealth visits, and recent legislation extended flexible telehealth rules through the end of 2027. You can receive virtual care from your home for both general medical needs and behavioral or mental health services, with no geographic restrictions. Visits can happen over video or, when you’re unable to use video technology, by phone alone. Mental health counselors and marriage and family therapists can also provide telehealth services under these rules.
Many plans go beyond the baseline, offering their own telehealth platforms with 24/7 access to a care team through phone, online portals, email, or virtual check-ins. These services often tie into broader care management features like chronic care coordination, personalized care plans, medication management, and help transitioning between settings after a hospital stay.
Benefits for People With Chronic Conditions
Since 2020, Medicare Advantage plans have been allowed to offer Special Supplemental Benefits for the Chronically Ill, known as SSBCI. These go well beyond traditional medical coverage and target people with conditions like diabetes, heart failure, chronic lung disease, or other ongoing health issues.
The benefits can be surprisingly practical. Plans may cover home-delivered meals or groceries (including produce, frozen foods, and canned goods) to help with nutrition. Transportation to non-medical destinations like grocery stores or banks is another option. Some plans cover pest control services, indoor air quality improvements like portable air conditioners or HEPA filters, and even carpet cleaning. Social needs benefits can include companion care, community club memberships, park passes, and programs designed to reduce isolation. Complementary therapies offered alongside standard medical treatment may also be included.
Not every plan offers these benefits, and they’re tailored to specific chronic conditions. Starting in 2025, plans must back up their SSBCI offerings with research demonstrating that the benefit has a reasonable expectation of improving health or overall function.
How Plan Type Affects Your Coverage
Medicare Advantage plans come in two main types, and which one you choose affects how freely you can see providers.
HMO plans require you to choose an in-network primary care physician and get referrals before seeing specialists. Outside of emergencies, out-of-area urgent care, and dialysis, services from out-of-network providers generally aren’t covered, meaning you’d pay the full cost yourself.
PPO plans offer more flexibility. You don’t need to choose a primary care physician or get referrals to see specialists. You can use both in-network and out-of-network providers, though you’ll pay less when you stay in-network. If seeing a variety of specialists or keeping a specific doctor matters to you, a PPO typically gives you more room.
Notification of Benefits You Haven’t Used
A newer federal rule requires Medicare Advantage plans to send you a personalized notice between June 30 and July 31 each year listing any supplemental benefits you haven’t used during the first half of the year. The notice must explain the scope of each unused benefit, your cost-sharing, how to access it, whether it requires using network providers, and a phone number for help. This is worth paying attention to, since many enrollees leave dental, vision, hearing, or fitness benefits on the table simply because they didn’t know they had them or forgot to use them.