What Does Medicare Advantage Cover?

What Medicare Advantage covers: the short answer

Medicare Advantage covers almost all medically necessary services Original Medicare covers, usually adds drug coverage, and often adds extras. It's a Medicare-approved plan from a private company, sometimes called Part C. It bundles Part A (hospital insurance) and Part B (medical insurance) into one plan. You need both Part A and Part B to join.

For the bigger picture, see what's changing in Medicare Advantage for 2027.

The rest of this page goes through each kind of care, and how to check your own plan.

Doctor visits and hospital care

Your plan covers almost all medically necessary services that Original Medicare covers. (Hospice care is one exception: Original Medicare still covers it.) That includes hospital stays, doctor visits, tests and outpatient care. What you pay for each one depends on your plan's copays and coinsurance.

The rules for getting that care can differ from Original Medicare:

• Networks: you may need to use doctors and hospitals in the plan's network and service area, except in an emergency.

• Referrals: you may need a referral to see a specialist.

• Prior authorization: you may need the plan's approval before it covers some services or supplies.

• Care outside the U.S.: plans generally don't cover it, though some offer an extra benefit for emergency and urgent care while you travel.

Every plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, you pay nothing more for covered services that year. Original Medicare has no such limit. You also can't buy a Medigap policy (supplemental insurance for Original Medicare) to cover Medicare Advantage costs.

Prescriptions

Most Medicare Advantage plans include Part D drug coverage. In most types of plans, you can't also join a separate Medicare drug plan.

Drug coverage in a Medicare Advantage plan follows the same Part D rules as a stand-alone plan. For 2027, once you've paid $2,400 out of pocket for covered drugs, you pay $0 for covered drugs for the rest of the year. Each plan has its own drug list, tiers and pharmacies. Some drugs need prior authorization or step therapy (trying a lower-cost drug first).

Our guide to Medicare Part D in 2027 explains drug lists, tiers and costs in more detail.

Telehealth

Medicare covers many telehealth services, including video visits from home, through December 31, 2027. Medicare Advantage plans may offer more telehealth benefits than Original Medicare. What you pay for a video visit depends on your plan.

Our guide to what telehealth services Medicare covers has the full list. Our answer on Medicare Advantage and telehealth explains what plans cover and what you pay.

Extra benefits: dental, vision, hearing and more

Most Medicare Advantage plans offer extra benefits that Original Medicare doesn't cover. Which extras you get, and how much they cover, varies by plan. Our short answers on what Medicare Advantage covers go through dental, hearing aids, eye exams and more, one by one. Original Medicare generally doesn't cover these:

• Dental: most dental care, like routine cleanings and fillings. Many plans add some dental coverage.

• Vision: routine eye exams for glasses or contact lenses.

• Hearing: hearing aids and the exams to fit them.

• Fitness: gym memberships and fitness programs.

Extras can change from year to year. Many plans are reducing extras like dental, hearing and transportation for 2027. Your Annual Notice of Change (the letter your plan sends each fall listing next year's changes) shows what your plan keeps.

Home health, physical therapy and eye exams

Your plan covers these services when they're medically necessary, as Original Medicare does. Your plan's own rules and costs apply.

• Home health care: Medicare covers part-time skilled nursing and therapy at home if you're homebound and a doctor orders it. Original Medicare charges nothing for covered home health services. Check your plan for its home health rules.

• Physical therapy: Medicare covers medically necessary physical therapy that a doctor or other licensed clinician certifies you need. In Original Medicare, you pay 20% of the approved amount after the Part B deductible. Your plan sets its own copay.

• Eye exams: your plan covers the eye care Original Medicare covers, like eye exams if you have diabetes and glaucoma screenings if you're at high risk. Routine exams for glasses are an extra benefit (see above).

Some plans also send a clinician to your home for a health check. Our guide to Medicare Advantage home visits explains what they are.

How to check what your plan covers

Your plan's Evidence of Coverage is the full description of what it covers, what you pay and the rules you follow. Your plan sends it each year and posts it online. Use it to check:

1. The service you need. Search for it by name, such as "hearing aids" or "physical therapy."

2. What you'll pay. Look for the copay or coinsurance, and whether a deductible applies.

3. The rules. Note any network, referral or prior authorization rule.

4. Your drugs. Check each one on the plan's drug list, with its tier.

If something isn't clear, call the member services number on your plan card. Doctronic isn't an insurance agent or broker and doesn't recommend plans. For free help comparing plans, use Medicare.gov, call 1-800-MEDICARE (1-800-633-4227), or contact your State Health Insurance Assistance Program (SHIP).

Need a prescription renewal or have a health question while you check your plan? A licensed doctor is available by video. Doctronic accepts Medicare.

Frequently Asked Questions

Does Medicare Advantage cover everything Original Medicare does?

Almost everything that's medically necessary. What can differ is what you pay and the rules, like networks and prior authorization.

Is there a limit on what I pay with Medicare Advantage?

Yes. Each plan caps your yearly costs for covered hospital and medical care, and the cap varies by plan. Drug costs have their own Part D cap ($2,400 in 2027).

Does Medicare Advantage cover care when I travel?

Within the U.S., emergency care is covered, but routine care may need to be in network. Plans generally don't cover care outside the U.S., though some add a travel benefit.

Can my plan's coverage change next year?

Yes. Plans can change their costs, coverage, networks and service area each year. Your Annual Notice of Change, sent each fall, lists the changes that start in January.

The Bottom Line

Before you rely on a benefit, check your plan's Evidence of Coverage for what it covers, what you pay and any approval rules.