Medicare Advantage plans cover everything Original Medicare covers, plus most plans bundle in extras like dental, vision, hearing, prescription drugs, and wellness benefits. These are private insurance plans approved by Medicare (also called Part C), and by law they must include all medically necessary services that traditional Medicare provides. Where they differ, and where they often appeal to enrollees, is in the supplemental benefits stacked on top.
All Medically Necessary Services
Every Medicare Advantage plan is required to cover the same hospital and medical services as Original Medicare. That includes inpatient hospital stays, doctor visits, lab tests, surgeries, preventive screenings, skilled nursing facility care, home health services, and durable medical equipment like wheelchairs or oxygen tanks. If Original Medicare would pay for it, your Medicare Advantage plan must too.
The key difference is how you access those services. Medicare Advantage plans use provider networks, and the type of plan you choose determines how strict those network rules are.
HMO vs. PPO: How Network Rules Affect Coverage
Most Medicare Advantage plans are structured as either an HMO or a PPO, and the distinction matters for what care gets covered in practice.
With an HMO plan, you generally must use doctors and hospitals within the plan’s network. The exceptions are emergencies, urgent care when you’re traveling, and temporary out-of-area dialysis. Many HMOs also require a referral from your primary care doctor before you can see a specialist. Some HMO plans (called HMO Point-of-Service plans) do allow out-of-network care for certain services, but you’ll pay higher copays or coinsurance.
PPO plans give you more flexibility. You can see out-of-network providers for covered services without a referral, though you’ll typically pay more than you would for an in-network provider. No specialist referral is required with a PPO.
Prescription Drug Coverage
Most Medicare Advantage plans include built-in prescription drug coverage, which is the equivalent of a standalone Part D plan. This covers both brand-name and generic medications. Each plan maintains a formulary, which is the list of drugs it covers, and those formularies vary from one plan to another. If you take specific medications, it’s worth checking whether they’re on a plan’s formulary before you enroll.
Plans that include drug coverage will have their own cost-sharing structure, with different copays depending on the tier your medication falls into. Generic drugs are almost always the cheapest tier, while specialty medications cost the most out of pocket.
Dental, Vision, and Hearing Benefits
Original Medicare does not cover routine dental care, eye exams for glasses, or hearing aids. These are some of the most common extras that Medicare Advantage plans add. The specifics vary widely between plans, but typical dental coverage includes preventive cleanings, X-rays, and sometimes more extensive work like crowns or dentures. Vision benefits often cover annual eye exams plus an allowance toward glasses or contact lenses. Hearing benefits may include hearing exams and a yearly allowance toward hearing aids.
The depth of these benefits differs significantly from plan to plan. Some offer only basic preventive dental, while others cover major procedures. Always check what’s included and what dollar limits apply before assuming a plan meets your needs.
Over-the-Counter Product Allowances
Many Medicare Advantage plans now provide a quarterly or monthly allowance you can use to buy everyday health products without a prescription. Eligible items typically include allergy and cold medicine, pain relievers, first aid supplies, incontinence products, stomach remedies, vitamins, and tobacco cessation aids. Some plans load these credits onto a benefits card you can use at participating pharmacies or retailers.
There are limits on what qualifies. Cosmetics, hair products, alcohol, pet items, candy, ice cream, and alternative supplements are generally excluded. The dollar amount of the allowance ranges from modest (around $20 to $40 per quarter on some plans) to several hundred dollars per quarter on more generous ones.
Fitness and Wellness Programs
A large number of Medicare Advantage plans include gym memberships at no extra cost. The most well-known program is SilverSneakers, which gives members access to thousands of participating fitness locations nationwide, from national gym chains to local community centers. Beyond gym access, SilverSneakers includes live online classes, on-demand workout videos, a fitness app for tracking activity and finding locations, community walking groups, and nutrition workshops.
Not every plan uses SilverSneakers specifically. Some offer competing programs like Silver&Fit or Renew Active, which provide similar benefits through different networks of gyms and fitness resources.
Telehealth and Virtual Visits
Medicare Advantage plans cover telehealth services, and current rules make access quite broad. Through the end of 2027, Medicare patients can receive telehealth for non-mental-health care from their own home, with no geographic restrictions. Audio-only visits (phone calls) are permitted when a patient can’t use or doesn’t want video. Mental and behavioral health telehealth services are permanently available from home, also with no geographic limits, and can be delivered by audio-only platforms as well.
Many Medicare Advantage plans go further by offering their own virtual care platforms with $0 copays for certain visit types, making it easy to see a doctor for minor issues without leaving home.
Benefits for People With Chronic Conditions
Medicare Advantage plans can offer a special category of supplemental benefits for enrollees with chronic illnesses. These go well beyond typical medical coverage and target the practical challenges that come with managing a long-term condition.
Eligible benefits include home-delivered meals on an ongoing basis (not just the short-term meals sometimes covered after a hospital stay), grocery and produce deliveries to help meet nutritional needs, and transportation for non-medical errands like grocery shopping or banking. Plans can also cover structural home modifications such as widening doorways, installing permanent mobility ramps, or replacing doorknobs and faucets with easier-to-use versions.
Some plans go further with pest control services, indoor air quality equipment like portable air conditioners or air purifiers, and social needs benefits designed to reduce isolation. These social benefits can include companion care, community club memberships, park passes, counseling services, and programs for enrollees who serve as primary caregivers for children. These benefits are available only to members who qualify based on their chronic condition, so not every enrollee in a plan will have access to all of them.
Emergency Care and Travel Coverage
All Medicare Advantage plans cover emergency care regardless of whether the hospital is in your network. If you’re having a medical emergency, you can go to the nearest emergency room anywhere in the country and your plan must cover it.
International coverage is more limited. Original Medicare only pays for care at a foreign hospital in narrow circumstances: when a foreign hospital is closer than the nearest U.S. hospital during an emergency, when a medical emergency happens while driving through Canada between Alaska and another state, or when a foreign hospital is simply the closest hospital to your home near the border. Medicare Advantage plans follow these same baseline rules but may offer additional coverage outside the U.S. If you travel internationally, check with your specific plan before your trip to understand what’s covered.
What’s Not Covered
Even with all the extras, Medicare Advantage plans still have gaps. Long-term custodial care (help with daily activities like bathing and dressing on an ongoing basis) is not covered. Cosmetic surgery is excluded. Most plans won’t cover care you receive outside your network except in emergencies, particularly with HMO plans. And while dental, vision, and hearing benefits are common, they’re not guaranteed on every plan and may come with annual caps that don’t fully cover major procedures.
Each plan also has a maximum out-of-pocket limit, which caps what you’ll spend in a year on covered services. Original Medicare has no such cap, so this built-in ceiling is one of the financial protections unique to Medicare Advantage. For 2025, these limits vary by plan but provide a hard stop on your annual spending for in-network care.