1 Freed M. et al. (Nov. 10, 2022). Medicare Advantage in 2023 Spotlight: First Look. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-2023-spotlight-first-look.
Part C
Medicare Part C Coverage
- January 5, 2023
- Reviewed by John Krahnert
Medicare Advantage plans provide the same coverage as Original Medicare, and most plans also provide prescription drug coverage, vision, dental and wellness program benefits, which Original Medicare does not cover.
Part C plans cover 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 Part C plans are required by law to cover all of the above benefits. The only exception is coverage of hospice care.
Medicare Advantage plans do not cover hospice care. However, you will still get hospice care through your Original Medicare benefits, even if you are enrolled in a Medicare Advantage plan.
Part C plans can offer additional benefits
Most Medicare Advantage plans provide prescription drug coverage.
Some Medicare Advantage plans may provide extra benefits such as:
- Routine dental and vision coverage
- Non-emergency transportation
- Home modifications to help you age in place
- Home meal delivery
- Fitness and wellness program memberships, such as SilverSneakers
Individual plan benefits and availability can vary depending on where you live and the type of Part C plan you have. Not all of these extra benefits will be available with Medicare Advantage plans in all areas.
Medicare Advantage plan benefits can change from year to year, so it's important to check with your plan each year to make sure it is still the best Medicare Advantage plan for your unique needs.
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Medicare Advantage and Durable Medicare Equipment (DME)
In addition to the Durable Medical Equipment (DME) that Original Medicare covers, Medicare Advantage plans may cover the following, depending on the particular plan:
- Adult Diapers
- Dentures
- Grab Bars
- Hearing Aids
- Incontinence supplies
- Personal Emergency Response Systems (LifeAlert)
- Prescription eyeglasses
- Prescription eyeglasses ordered online
- Compression stockings
- Shower chairs
- Wigs for cancer patients
Some Medicare Advantage plans may also provide coverage for equipment like wheelchair ramps and air conditioners for people with asthma.
Ask a licensed insurance agent what additional benefits may be covered by the plans you are considering.
Prescription drug coverage
Some Medicare Advantage plans may include prescription drug coverage.
In 2023, 89% of Medicare Advantage plans offer prescription drug coverage.1
Each plan has its own formulary, which is a list of drugs and brand names the plan provider will cover.
In a Medicare formulary, drugs are separated into different tiers.
- Common and less expensive generic drugs are typically grouped into a lower tier.
- Rare, more expensive brand name drugs and specialty drugs are typically grouped into a higher tier.
The coverage for each category of drug may vary from one plan to the next.
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 and vision benefits
While Medicare Part B offers some coverage related to vision, it doesn't cover routine eye exams or glasses. Some Medicare Advantage plans, however, offer these benefits.
Part C plans that include vision coverage may include benefits for services and items such as:
- Glaucoma screenings
- Cataract surgery
- Prosthetic eyes
- Routine eye exams
- Allowances for prescription glasses or contact lenses
Some Medicare Advantage plans even offer coverage for designer eyeglasses such as glasses from Warby Parker.
Medicare Part B similarly does not typically cover most dental care services.
Some Medicare Part C plans, however, may offer dental benefits such as:
- Routine dental exams and checkups
- Teeth cleaning
- Dental X-rays
- Root canals, bridges, crowns and other dental work
- Allowances for dentures
Hearing care coverage
Hearing loss is among the most common age-related health complications.
While Original Medicare does not provide any coverage for routine hearing exams or hearing aids, some Medicare Advantage plans may offer these benefits.
Medicare Advantage plans that cover hearing care may offer benefits such as:
- Routine hearing tests and hearing exams
- Allowances for hearing aids
- Hearing aid fittings and maintenance
Health and wellness program memberships
Another unique benefit that some Medicare Part C plans may offer is membership to gyms and wellness programs.
Among the most popular of these types of fitness programs is SilverSneakers, which is a fitness program catered to older adults.
SilverSneakers has thousands of participating locations across the U.S. and includes access to exercise classes, outdoor activities, recreational sports leagues, yoga, swimming pools and other gym facilities and much more.
Medicare Part C expanded benefits in 2023
In recent years, the Centers for Medicare & Medicaid Services (CMS) approved new additional benefits that can be offered by Part C plans.
Some of these new benefits can include things like:
- Transportation for non-emergency medical care, including with the popular ride-sharing company Lyft
- Over-the-counter (OTC) health items
- Home modifications intended to help you age-in-place, such as wheelchair ramps, handrails and bathroom grab bars
- Home health care and caregiver support
- Air conditioners for people with asthma
- Coverage for people who have End-Stage Renal Disease (ESRD)
A licensed insurance agent can help you find 2023 Medicare Advantage plans available in your area that offer the benefits you need.
How to enroll in Medicare Part C
Enrolling in a Medicare Advantage plan does not mean that you are disenrolling from Original Medicare. In fact, you must enroll in Original Medicare in order to belong to a Medicare Advantage plan.
You will still technically have Original Medicare (and in most cases, you must continue to pay your Medicare Part B premium), but your health insurance coverage will come from your Medicare Advantage plan carrier.
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.
To learn more about Medicare Advantage plans and to find plans in your area, call a licensed insurance agent today or compare plans online.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
