Medicare Advantage TV advertisements have become a familiar sight, promising a wealth of extra benefits to entice seniors into enrolling. With promises of low-cost dental care, vision exams, hearing aids, over-the-counter medication coverage and gym memberships, these ads paint a picture of a comprehensive health plan that goes beyond basic Medicare coverage.
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As these ads multiply, so does the popularity of Medicare Advantage. In 2024, 32.8 million seniors opted for a Medicare Advantage plan, representing 54% of the eligible Medicare population, according to an analysis by KFF, a nonprofit, nonpartisan health care research institute. On average, beneficiaries could choose from 43 Advantage plans, offering a wide array of various benefits. A key appeal of these plans lies in their supplemental, or “extra,” benefits that go beyond what original Medicare provides.
“There are several factors beneficiaries consider when choosing coverage to best meet their health needs, including supplemental benefits,” says Susan Reilly, vice president of communications at Better Medicare Alliance in Washington, D.C. “For many beneficiaries, these crucial benefits help close coverage gaps and promote better overall health.”
[READ: Medicare Advantage Initial Enrollment Period and Special Enrollment Periods]
What Is Medicare Advantage?
Medicare Part C, also known as Medicare Advantage, is an alternative to original Medicare (Parts A and B) offered through private insurance companies approved by Medicare. They are required by law to cover everything that Part A (hospital insurance) and Part B (medical insurance) cover and beneficiaries find this bundling of insurance coverage and supplemental benefits that they provide appealing.
Advantage plans may have a premium above the Part B premium that beneficiaries must continue to pay, although most plans are low or no cost. Other out-of-pocket costs, such as co-pays or coinsurance for Medicare Advantage plans, will differ by plan. Most plans require using a network of health care providers within a geographical region and care outside the region or network may cost more. Other requirements such as prior authorizations may be necessary before covered care can move forward.
[READ Worst Medicare Advantage Plans: How to Find a Good One]
Popular Benefits
There are many things to like about Advantage plans, including the supplemental benefits that plans offer above and beyond what is covered by original Medicare. They are a popular feature that makes Medicare Advantage plans more appealing to potential members and offer additional value compared to original Medicare.
The most common supplemental benefits include:
— Over-the-counter allowance
— Dental
— Hearing
— Routine vision
— Fitness
Depending on the plan, other benefits — such as transportation or meal service after a qualified hospital stay — may be offered.
You must check the benefit summary of the plan you are considering as the benefits may not be as comprehensive as you may need. For example, just because it offers dental benefits, does not mean that it covers everything within that category.
Plans also vary in terms of cost sharing and many have an annual dollar cap on what it will pay towards covered services. There may also be a limit on the number of services or doctor visits per year. Many require using in-network providers and pre-authorizations may be necessary.
[READ: Medicare Advantage HMOs vs. PPOs: Which Is Right for You?]
Over-the-Counter Allowances
Plans that offer over-the-counter drug allowances will decrease in 2025 to 73% from 84% in 2024, according to KFF. These benefits are important, however, as they provide practical, cost-effective support for seniors, contributing to better health management.
Access to OTC medications encourages preventive care by allowing seniors to manage minor health issues, like colds or pain, before they escalate into more serious problems requiring medical help. Also, many seniors have fixed incomes, and OTC medication benefits reduce out-of-pocket expenses for essential health items.
Some essential health items that may be included are:
— Aspirin and other pain relievers
— Bandages and other wound care items
— Blood pressure cuffs
— Hygiene products
“Enrollees receive a specific dollar amount to purchase eligible items and benefits are often redeemed through prepaid cards, mail-order catalogs or approved retailers,” Reilly says.
For example, Cigna plans that have an OTC benefit provide a quarterly allowance to help cover not only the cost of OTC medications, but also health and wellness products. Members receive those benefits in the form of a prepaid card to use when purchasing items.
Dental Benefits
In 2025, dental benefits are expected to be available in 98% of Advantage plans, according to KFF. This is important because older adults are at higher risk for dental problems, such as cavities, gum disease and tooth loss. Such issues can lead to expensive dental procedures, including:
— Fillings
— Gum surgery
— Root canals
— Tooth extractions
Additional costs may arise for dental appliances such as implants, crowns or dentures. While dental benefits are included in most Advantage plans, the scope of the specific services covered varies. Many plans only include routine dental care such as cleanings and x-rays.
Speak to your dentist to see what services you may need in the near future and check to see if your particular plan covers it and what requirements they have, such as pre-authorizations.
Hearing Benefits
In 2025, 97% of Advantage plans include hearing benefits according to KFF. Hearing benefits in Medicare Advantage plans are important because hearing loss is a common issue among older adults. Hearing loss can significantly impact communication, leading to social isolation, depression and cognitive decline. Hearing benefits help individuals stay socially connected and engaged in daily activities.
Hearing aids can be expensive, with costs ranging from hundreds to thousands per device. Many Medicare Advantage plans offer coverage or discounts for hearing aids, making them more affordable. Some even cover follow-up services such as fittings or adjustments.
Some states have mandated that Advantage plans provide these benefits. The five states that have mandated coverage of hearing aids in Advantage plans include:
— Arkansas
— Connecticut
— Illinois
— New Hampshire
— Rhode Island
Vision Benefits
In 2025, more than 99% of Advantage plans are expected to offer vision benefits, according to KFF. This is important because care — such as regular eye exams, prescription eyewear and treatments — becomes increasingly necessary as we age. These benefits address a critical aspect of overall health and well-being for those who are at increased risk for cataracts, glaucoma and other eye-related conditions. Regular eye exams can help catch problems before they become too serious.
Many plans limit coverage to biannual exams and limited coverage for glasses or contacts, but every plan is different, so look at the plan’s benefits summary to make sure it covers what you need.
Fitness Benefits
Fitness benefits are estimated to be offered in 95% of Advantage plans in 2025, according to KFF. Physical activity can help manage chronic conditions, like diabetes, high blood pressure and arthritis. It also supports mental health and overall mobility. Encouraging fitness can help prevent falls, hospitalizations and other costly medical problems, which benefits both the patient and the insurer.
Some plans offer fitness benefits, such as:
— Coverage for fitness trackers or related technology
— Free or discounted gym memberships
— Online fitness classes or home exercise programs
— Wellness coaching or personal training sessions
Bottom Line
Original Medicare does not cover certain services like routine dental, vision, hearing, fitness and OTC benefits. These supplemental, or “extra,” benefits are a key feature that enhances the appeal of Medicare Advantage plans, providing added value to beneficiaries.
Each plan offers different benefits and at different levels, so it is important to check a plan’s offerings to make sure what you need is covered. These benefits improve affordability, promote preventive care and improve beneficiaries’ overall health and well-being, making them a valuable component of comprehensive health coverage.
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Benefits Offered by Medicare Advantage originally appeared on usnews.com
