What extra benefits can Medicare Advantage plans offer?

What extra benefits do Medicare Advantage plans offer?

Medicare.gov says Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, like some vision, hearing and dental services. The Medicare & You 2027 handbook and Medicare.gov list examples of what some plans may cover:

• Vision care
• Hearing care
• Dental care, like check-ups or cleanings
• Certain gym memberships or discounts
• Rides to doctor visits
• Over-the-counter drugs that Part D doesn't cover
• More telehealth benefits than the basic coverage in Original Medicare
• Emergency and urgently needed services when you travel outside the U.S.

Which of these does Original Medicare cover?

Original Medicare doesn't cover most of these: it doesn't cover routine eye exams for eyeglasses or contact lenses, hearing aids or the exams to fit them, gym memberships or fitness programs, or most dental care, like cleanings, fillings, tooth extractions and dentures. There are limited exceptions: Part B covers one pair of eyeglasses with standard frames after each cataract surgery that implants an intraocular lens, and Medicare may cover some dental services tied to certain covered medical treatments. See what Medicare covers for dental, vision and hearing.

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers; extra benefits are on top of that.

What are benefits for people with chronic illnesses?

The Medicare & You 2027 handbook says plans can also offer additional benefits customized to treat people with specific conditions and certain chronic illnesses. You can check with a plan before you join to find out whether it offers these benefits, but you'll need to wait until you join to find out if you qualify.

Special Needs Plans, a type of Medicare Advantage plan for people with specific severe or chronic diseases, certain health care needs, or Medicaid, tailor their benefits to the groups they serve. Medicare.gov says a Special Needs Plan might cover extra services, like extra days in the hospital for someone with a severe condition. See how Special Needs Plans work.

Do extra benefits cost more?

Sometimes. Medicare.gov lists whether a plan offers extra benefits, and what it charges for them, among the things that affect what you pay in a Medicare Advantage plan. A plan may charge extra for them. Each year plans set their own premiums, deductibles and copayments, and what you pay the plan can change only once a year, on January 1. You also must keep paying your Part B premium to stay in the plan ($202.90 a month in 2026, or more with a higher income), unless the plan helps pay all or part of it with a Part B premium reduction.

How do I check a plan's extra benefits before I join?

Read the plan's documents and ask the plan. The Medicare & You 2027 handbook says extra benefits are generally limited, so check with the plan before you join to find out exactly what is covered and whether the benefits are available to you. These help:

• Evidence of Coverage: details about what the plan covers, how much you pay and more for the next year. Plans send a notice or printed copy by October 15.
• Annual Notice of Change: changes in coverage, costs and more that start in January. Plans send it by September 30.
• Medicare.gov/plan-compare lets you find and compare health and drug plans in your area.

Can Medigap pay for these extras instead?

Generally not. Medicare.gov says Medigap policies generally don't cover vision, dental, hearing aids, long-term care, private-duty nursing or prescription drugs, though some Medigap policies offer coverage when you travel outside the U.S. Medicare.gov's page on gym memberships says fitness programs may be part of the extra coverage some Medicare Advantage plans, other Medicare health plans or Medigap plans offer. You can't use a Medigap policy to pay Medicare Advantage costs.