Medicare Advantage Plans – A Guide to Services and Benefits
As per the Commonwealth Fund, it is forecasted that more than 35 million people, which is over 50 percent of all beneficiaries, will enroll in Medicare Advantage plans in 2025. Medicare Part C is gaining more and more acceptance among older people in America, mostly because of the additional benefits that these plans provide, including coverage for dental, vision, and wellness.
The program also bundles additional services that improve the health and quality of life of senior citizens. Part C covers vision, dental services, and in some cases, drug coverage. Next, you will read the services that Medicare Part C provides and combines.
What is a Medicare Advantage Plan?
Medicare Advantage is an alternative to Original Medicare, which includes Part A and Part B. Also known as Part C, these plans are offered by private insurance companies under the approval of the Centers for Medicare and Medicaid Services (CMS).
Part C can also combine the benefits from Part A (hospital care) and Part B (medical care) to provide extensive coverage for extra benefits beyond Original Medicare. These include wellness and fitness, dental, drugs, and vision. Part C has a pre-defined network of doctors, hospitals, and healthcare service providers available to you.
Restrict Access, Not a Problem
Though it can restrict your access somewhat in return, it offers benefits that Original Medicare does not offer, such as a yearly cap on out-of-pocket expenses. You must still continue paying your Part B premium in order to enroll in a Medicare Advantage plan.
Core Medicare Benefits Offered for Enrollees
Every Medicare Advantage plan is required to include:
Hospital Insurance (Part A)
- Inpatient hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health care
(H3) Medical Insurance (Part B)
- Doctor visits
- Preventive services (screenings, vaccinations)
- Outpatient care
- Durable medical equipment
Services Covered By Medicare Advantage Plans
Medicare Part A and B provide very basic services; however, the majority of Medicare Advantage plans offer additional services. Here is the breakdown of the specifics:
1. Dental Services
According to a KFF report, over 97% of Medicare Advantage plans now include some form of dental coverage. Services may include:
- Routine cleanings
- Exams and X-rays
- Fillings
- Crowns or dentures
2. Vision Care
Most Medicare Advantage plans cover vision care as part of the coverage.
- Annual eye examinations
- Eyeglasses or contact lenses allowance
- Post-surgical cataract care
3. Hearing Services
Part C also includes coverage for hearing services:
- Annual hearing tests
- Discounts or coverage (in some cases) for hearing aids
- Devices and accessories
5. Over-the-Counter (OTC) Allowance
Many Medicare Advantage plans offer quarterly or monthly OTC allowances that can be used for:
- Pain relievers
- Cold medications
- First-aid supplies
- Vitamins and supplements
Listing the Value-Added Services
1. Transportation Services
For hospital visits or care needed in medical facilities, Medicare Advantage plans may offer:
- Non-emergency medical transportation charges for commute
- Travel vouchers or allowances for solo and ride-sharing
- Coverage for participants who cannot drive or have limited mobility
2. Fitness Programs
Medicare Advantage plans are increasingly offering wellness and fitness coverage for enrollees. Over 90% of plans now provide fitness benefits, such as gym memberships, fitness classes, and wellness programs.
- SilverSneakers
- Renew Active
- Gym memberships (including discounts)
- Yoga or tai chi sessions
3. Meal Delivery
The service usually applies for a maximum of 14 days post-hospitalization. Some plans offer life-maintaining meals like post-surgical or recovery-specific foods. These are usually low-sodium or diabetic meals.
4. Telehealth and Virtual Care
Telehealth became much more common during COVID-19 and is now recognized by many Medicare Advantage plans. Nearly all MA plans provide access to virtual visits for primary care, urgent care, behavioral health, and prescription refills.
- Primary care
- Mental health counseling
- Prescription management
- Medical follow-ups
- Urgent care
- Home dialysis
- Acute stroke evaluation
- Behavioral health therapy
Special Supplemental Benefits for the Chronically Ill (SSBCI)
Since 2020, CMS permits plans to provide benefits for enrollees suffering from chronic illness. These may consist of:
- Home air purifiers for people with respiratory problems
- Nutritional support
- Pest control for private residences
- Non-medical home caregiving
Policy Changes for 2025
CMS made some important policy updates to Medicare Advantage for the 2025 coverage year:
1. Increased Star Ratings Transparency
Plans are now subject to stricter scrutiny when being rated, including consumer complaints, coverage options, chronic disease management, and healthcare equity.
2. Greater Availability of Behavioral Health Services
Medicare Advantage plans are expected to provide broader access to behavioral health treatment and add more related medical service providers to their networks.
3. Enhanced Supplemental Benefits Review
CMS is assessing whether the offered supplementary benefits are available and easily accessible to plan members.
Expenditures and Factors to Think About
Despite the fact that many Medicare Advantage plans have $0 premiums, make sure to look for cost-sharing features such as:
- Deductibles
- Copayments
- Out-of-pocket maximums
Medicare Advantage plans usually come with their own network of providers, which narrows the options available when compared with Original Medicare. Generally, HMO plans need referrals, while PPO plans allow greater access to the network.