What services are covered by Medicare Advantage that Original Medicare does not cover?
Executive summary
Medicare Advantage (Part C) covers everything Original Medicare (Parts A and B) does and commonly adds bundled Part D prescription coverage plus extra benefits such as routine dental, vision and hearing, fitness and some nonmedical “perks,” and an annual out‑of‑pocket maximum that Original Medicare lacks (sources: [8], [1], p1_s2). Plans vary by insurer and county; CMS and insurers emphasize that most MA enrollees will see the same or lower premiums and many MA plans offer $0 premiums and additional services not in Original Medicare (sources: [6], p1_s8).
1. What MA adds that Original Medicare generally does not: routine dental, vision and hearing
Medicare Advantage plans routinely offer benefits for routine dental, vision and hearing services that Original Medicare does not cover as standard. Industry and plan guides list routine dental cleanings, coverage for eyeglasses and hearing aids among the extra services MA plans may include, and UnitedHealthcare highlights access to dental, vision and hearing benefits as features “not available through Original Medicare” (sources: [1], p1_s8).
2. Prescription drugs bundled (Part D) — often included inside MA
Original Medicare itself does not include outpatient prescription drug coverage; beneficiaries need a standalone Part D plan. Many Medicare Advantage plans combine Part A, Part B and Part D into a single MA‑PD product, so enrollees get drug coverage as part of their MA plan rather than buying a separate Part D policy (sources: [9], [5]4).
3. Financial protections: annual out‑of‑pocket maximums MA provides but Original Medicare lacks
A major structural difference is cost protection: Medicare Advantage plans come with an annual out‑of‑pocket maximum for covered services, providing a hard cap on a beneficiary’s exposure that Original Medicare does not offer (sources: [10], p1_s3). For 2026 the MA in‑network cap was discussed in reporting, highlighting predictable maximums as a selling point [1].
4. Lifestyle and nonmedical “perks” — transportation, meals, fitness and limited travel coverage
Private MA plans frequently market nonmedical supports — transportation assistance, meal delivery after discharge, fitness memberships and other social‑needs supports — that Original Medicare does not cover. Some plans also advertise limited overseas emergency coverage; these “perks” vary by plan and are increasingly a focus of plan marketing (sources: [1], p1_s6).
5. Trade‑offs: network rules, prior authorization and plan variability
Those added benefits come with trade‑offs. Medicare Advantage is delivered by private insurers and often requires use of in‑network providers and prior authorization for some services; Original Medicare generally offers broader provider choice and fewer utilization controls [2] [3]. Coverage and costs differ by plan and county, so two beneficiaries in the same city can have materially different benefits [1].
6. Costs and premium realities — $0 premiums for many enrollees but still Part B due
CMS and industry data show many Medicare Advantage enrollees will face $0 plan premiums and that average MA premiums were projected to be low or decline, but beneficiaries still pay the federal Part B premium and may face copays or deductibles within their MA plan (sources: [6], [4], p1_s9). UnitedHealth highlights $0 premiums and $0 copays for primary care in some 2026 offerings, underscoring variability across carriers [4].
7. Policy changes and market dynamics that affect extra benefits
CMS and insurers are actively shaping how MA plans market and design benefits; CMS emphasizes program stability while updating enforcement and plan rules, and insurers sometimes exit markets or change benefit packages year to year. That means extra MA benefits are not guaranteed long‑term — they depend on plan decisions, CMS rules and local market competition [5] [6] [7].
8. How to evaluate and pick: check plan details, networks and longevity of extra benefits
Because MA benefits vary by plan, the practical step is to compare plans in your county for the upcoming AEP (open enrollment dates cited by CMS) and read benefit booklets for covered dental/vision/hearing services, Part D formularies, network rules and out‑of‑pocket limits. Resources from CMS and consumer organizations emphasize side‑by‑side comparison because many MA advantages are plan‑specific [5] [3] [1].
Limitations and unanswered items: available sources describe the typical extra services MA offers and plan‑level variability but do not provide an exhaustive, uniform list of every service a Medicare Advantage plan must or must not cover nationwide; for granular, plan‑specific coverage and costs consult the plan’s Evidence of Coverage or Medicare.gov plan finder (not found in current reporting; see [3], p1_s3).