Surprising things that your Medicare Advantage plan may cover

If you’re 65 or older and are thinking about changing your Medicare plan, you may want to grab your tablet or smartphone to take some e-notes.

If you’ve already got an Original Medicare plan, you know that you get hospital insurance through Medicare Part A and doctor insurance through Medicare Part B.

But maybe your neighbor told you about their Medicare Advantage plan (aka Medicare Part C), and how it offers them advantages. One of the biggest is that Medicare Advantage plans usually offer extra benefits not found in Original Medicare. Read on to learn more.

Thinking about a Medicare Advantage plan? Call a licensed insurance agent at (800) 827-9990to talk about available plans, or browse your options online today.

What are some differences between Original Medicare and Medicare Advantage?

By law, Medicare Advantage plans, which you get through a private insurance company, must cover everything that Original Medicare does. However, most Medicare Advantage plans have more benefits, often with no additional monthly bill (premium), than Original Medicare.

Perhaps the most common example is prescription drug coverage, which Original Medicare doesn’t include. In fact, more than 90% of beneficiaries have access to a Medicare Advantage plan that includes drug coverage at no extra cost. If you’re on Original Medicare, you must buy a stand-alone Medicare Part D plan if you want this coverage.

Getting drug coverage is important for 2 reasons:

• It will help you pay for covered prescription drugs you may need.
• It will help you avoid a late-enrollment penalty if you sign up later. This penalty equals 1% of the “national base beneficiary premium” ($34.70 in 2024) for each month you skip coverage.

“It compounds, and it’s cumulative. You owe it the rest of your life,” says Ari Parker. He’s the author of It’s Not Complicated: The Three Medicare Decisions to Protect Your Health & Money and cofounder of Chapter, which offers free Medicare resources to older adults.

Beyond prescriptions, Medicare Advantage plans can offer other benefits that aren’t included in Original Medicare. They fall into 3 broad categories, which we’ll discuss next.

1. Traditional supplemental benefits

Besides prescription drug coverage, many Medicare Advantage plans may offer traditional supplemental benefits. These are benefits that you normally wouldn’t be able to get through Original Medicare. For example, plans may include routine:

• Dental
• Hearing
• Vision

Virtually all plans offer at least 1 of these benefits, with vision and hearing being the most common add-ons.

2. Expanded health benefits

Since 2019, Medicare Advantage plans have been able to offer expanded primarily health-related benefits, or EPHRB for those who qualify and only on certain plans like C-SNP’s. These benefits can help you get over or cope with health issues and reduce avoidable trips to the doctor or hospital.

3. Benefits for people with chronic illnesses

Since 2020, Medicare Advantage plans have been able to offer special supplemental benefits for those who qualify due to income or chronic condition, or SSBCI to assist with every day healthcare needs.

Keep in mind that these benefits, unlike those in other categories, are limited to people who qualify due to income or a chronic condition.

How do I know what supplemental benefits are included in my Medicare Advantage plan?

When you browse Medicare Advantage plans online, the most common supplemental benefits will appear under the “plan benefits” heading of that specific plan. (You can also call a licensed insurance agent at (800) 827-9990 to discuss your options.) You can see even more benefits — and details on what they cover — by reviewing your “plan details.”

The details are important, because what each benefit covers can vary, sometimes by a lot. Take dental benefits, for example. “Some plans only offer preventive work like cleanings,” Parker says. “Others offer a more robust, comprehensive dental benefit, which is usually what people are thinking about.”

The same is true for vision benefits. Some plans only offer a discount card, while others offer money toward a new pair of eyeglass frames, Parker notes.

If you’re interested in a specific benefit, Parker recommends reviewing each plan’s summary of benefits to know exactly what you’re getting. This document is available on the insurance company’s website.

How do I know which Medicare Advantage plan fits me best?

As you review different Medicare Advantage plans’ supplemental benefits, it helps to think about which ones you may need and are likely to use. For example, if you have chronic leg pain and live alone, rides to doctor appointments and the grocery store could be a huge benefit.

On the other hand, if you’re hoping to get back in shape, a gym membership might be more valuable — if you use it, of course. When choosing a Medicare Advantage plan, a lot of people love the fitness benefit option. “Then it just depends on what their commitment to the gym is,” Parker says.

When you’re choosing a plan, Parker recommends thinking about what he calls the 3 P’s: providers, prescriptions and priorities.

1. First, see whether your providers are in the network.
2. Then, make sure there’s coverage for all the prescriptions you take.
3. Finally, think about what your other priorities are. For example, if you need regular trips to the eye doctor, a vision benefit might be best.

But keep in mind that those “other priorities” will vary from person to person, “If there’s a plan that does a better job of covering providers or prescriptions, then I wouldn’t recommend optimizing for the supplementary benefits,” Parker says. “That would be like picking a sundae for the cherry on top.”

Shopping around for a Medicare Advantage plan? Call a licensed insurance agent at (800) 827-9990 to talk about available plans, or browse your options online today.