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.

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:

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.

Prescription drug coverage

Some Medicare Advantage plans may include prescription drug coverage.

In 2019, 90% of Medicare Advantage plans offered 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 plan coverage expands in 2020

Starting in 2019 and 2020, 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

  • 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

A licensed insurance agent can help you find 2020 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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