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What Does Medicare Advantage Cover


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If you’re new to Medicare, you may be aware that you have coverage options. You can get your Medicare benefits from Original Medicare (Part A and Part B) administered by the federal government, or through Medicare Advantage, administered by private insurance companies. Rest assured that if you sign up for a Medicare Advantage plan, you will not have less coverage than if you had stayed with Original Medicare. Medicare Advantage plans are required to cover everything that Original Medicare covers. Medicare Advantage plans may also offer supplemental benefits not generally covered by Original Medicare. If you have Medicare Advantage, you’re still in the Medicare program and you still have Medicare rights and protections, including the right to appeal a coverage decision.

What does Medicare Advantage cover: required benefits

Medicare coverage is determined by federal and state laws, as well as national coverage decisions about whether something is covered.

Medicare Advantage plans cover medical costs covered by Medicare Part B, such as:

  • Doctor visits
  • Laboratory tests and x-rays
  • Emergency ambulance services
  • Mental health services (inpatient and outpatient)
  • Durable medical equipment such as wheelchairs and walkers
  • Preventative care including vaccines
  • Rehabilitative services including physical therapy, occupational therapy, and speech-language pathology

Medicare Advantage plans also cover hospital costs covered by Medicare Part A, such as:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care as long as custodial care isn’t the only care you need
  • Home health services

If you have Medicare Advantage, hospice care is still covered by Medicare Part A.

All Medicare Advantage plans cover emergency and urgent care.

What does Medicare Advantage cover: supplemental benefits

Medicare Advantage plans may offer benefits for services not generally covered by Original Medicare. Supplemental benefits may vary from plan to plan but this coverage could include:

Coverage Category Specific Services that may be covered
Prescription drugs The coverage of specific prescription drugs may vary from plan to plan. To find out if your medications are covered, check the plan’s formulary or list of covered prescription drugs. Prescription drug types Medicare Advantage plans are required to cover include:

·       certain vaccines including pneumococcal and influenza

·       certain oral anti-cancer drugs

·       hemophilia clotting factors

·       immunosuppressive drugs

·       some antigens

·       Injectable drugs for osteoporosis.

Routine Dental ·       Cleanings

·       X-rays

·       Annual exams

·       Extractions

·       Fillings

·       Root canals

·       Gum disease treatment

·       Crowns, bridges, dentures

Routine vision ·       Routine eye exams

·       Contact lenses

·       Eye glasses

·       Lenses, frames, upgrades

Inpatient hospital acute or psychiatric Additional days
Skilled nursing facility Additional days
Podiatry Routine care
Routine hearing ·       Routine hearing exams

·       Fitting evaluation for hearing aids

·       Hearing aids

Wellness benefits ·       Gym memberships

·       Fitness programs

What should I do if my Medicare Advantage plan doesn’t cover something I need?

If your Medicare Advantage plan denies

  • A request for a health care service, item, or prescription drug you think you should get
  • A request for payment for a health care service, item, or prescription drug you already got OR
  • A request to change the amount you must pay for a health care service, item, or prescription drug

You have the right to appeal this decision.

Are you interested in finding a Medicare Advantage plan in your area? Just enter your zip code on this page to begin comparing plans.

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