Medicare Part C Coverage

3 things to know about what Medicare Advantage plans cover:

1. All plans include at least the same coverage as Original Medicare (Part A and Part B).
2. Most Part C plans provide prescription drug coverage.
3. Some plans provide coverage for dental, vision, and wellness programs.

All Medicare Advantage plans provide at least the same coverage as Original Medicare. Some plans may also provide additional benefits such as drug, vision, dental, and wellness program coverage.

Before you enroll in a particular Medicare Advantage plan, you should carefully review the benefits and the out-of-pocket costs it can help cover.

After you have enrolled, you can always check with your Medicare Advantage plan provider to see if a particular medical service is covered. If you receive treatment that is not medically necessary and not covered by your Medicare Advantage plan, you may have to pay all of the costs.

You can request a written advance coverage decision from your insurance company to ensure that the service will be considered medically necessary and will be covered.

Original Medicare benefits

All Medicare Advantage plans include the same standard benefits as Medicare Part A and Part B.

Medicare Part A benefits include coverage for inpatient hospital stays, hospice care for those with a terminal illness, skilled nursing facility care, and some home health care.

Medicare Part B benefits include coverage for diagnostic services, routine doctor services, outpatient care, medical equipment, and other non-emergency medical care.

Medicare Advantage plans do not cover hospice care. However, you will still get hospice care through Original Medicare even if you are enrolled in a Medicare Advantage plan.

Additional benefits

Some Medicare Advantage plans may provide extra benefits such as drug, dental, and vision coverage, depending on the type of plan you have.

Medicare Advantage plan benefits can change from year to year.

Prescription drug coverage

Some Medicare Advantage plans may include prescription drug coverage.

In 2019, 90% of Medicare Advantage plans offered prescription drug coverage, according to the Kaiser Family Foundation.¹

Each plan has its own formulary, which is a list of drugs and brand names the plan provider will cover. Before enrolling, you should review a plan’s formulary to ensure that your particular medications are covered.

If your Medicare Advantage plan does not provide prescription drug coverage, you may be able to enroll in a Medicare Part D prescription drug plan (PDP). However, some Medicare Advantage plans, like HMO plans and PPO plans, have rules which prohibit you from enrolling in a PDP.

Dental & Vision

Some Medicare Advantage plans provide extra benefits including vision, hearing, dental, and health and wellness program coverage.