Key Takeaways

• Extra perks offered by some Medicare Advantage plans may distract you from evaluating what really matters: coverage rules, network limitations, and out-of-pocket costs.

• Choosing a plan based solely on add-ons like gym memberships or dental cleanings could result in denied care, higher copayments, or limited provider access when you actually need medical treatment.

Why the Extras Catch Your Attention First

Medicare Advantage plans in 2025 are marketed aggressively. You’ve probably seen advertisements promising perks like fitness benefits, dental coverage, transportation, and grocery cards. These extras are appealing. They’re easy to understand and feel like immediate value.

But the core of any Medicare Advantage plan is medical coverage. That includes doctor visits, hospital stays, prescriptions, and specialty care. If those areas fall short, no amount of perks will protect you when you face a major health issue.

What the Ads Leave Out

When you pick a Medicare Advantage plan based on benefits outside of basic healthcare, you might not notice how restrictive the plan can be in other areas:

• Narrow provider networks: Many plans only cover care from a specific list of doctors or hospitals.

• Referral requirements: Some plans require you to get permission from your primary care doctor before seeing a specialist.

• Prior authorization: You might need approval before getting a test, surgery, or even medication.

• Out-of-pocket maximums: Although there’s an annual cap, the way you reach it varies widely by plan.

Perks are optional. But those restrictions? They apply every time you seek medical care.

What You Should Really Be Comparing

It’s fine to consider extra benefits, but they shouldn’t be the reason you choose one plan over another. What matters more:

• Network access: Are your doctors and hospitals in-network?

• Costs for common care: What will you pay for things like primary visits, labs, imaging, or emergency care?

• Coverage rules: Are there many requirements for referrals or authorizations?

• Prescription drug coverage: Are your medications on the plan’s formulary, and how much will they cost?

• Out-of-pocket cap: What’s your maximum exposure if you need frequent or expensive care?

In 2025, the maximum in-network out-of-pocket limit allowed for Medicare Advantage plans is $9,350. Some plans set this lower, but only if you stay within the network. Out-of-network care, if allowed at all, may have a separate and much higher limit.

The Misleading Simplicity of Supplemental Benefits

Dental, vision, hearing, and even transportation are often bundled into Medicare Advantage plans as supplemental benefits. But these services typically come with limits:

• Dental: Cleanings and basic services may be included, but major procedures often have caps (e.g., $1,000 to $2,000 annually).

• Vision: An eye exam might be covered yearly, but glasses or contacts often have tight allowances.

• Hearing: Some plans offer hearing exams and hearing aids, but the aid itself might only be partially covered.

• OTC/grocery cards: These vary widely in value and usage, and some restrict what you can buy or where.

You may never hit the coverage ceiling on dental or vision, but you’re almost guaranteed to be affected by your plan’s medical rules and cost-sharing requirements. That’s why they deserve more attention.

Medicare Advantage Plans Are Not All the Same

You may assume all Medicare Advantage plans follow the same rules, but they don’t. While they are required to cover everything Original Medicare covers, they have discretion in how they do it. For example:

• Copay amounts vary by plan and can apply differently to outpatient surgery, diagnostic scans, or rehabilitation.

• Tiered drug pricing means your medications could be inexpensive with one plan and unaffordable with another.

• Pre-authorization rules may apply to hospital stays, advanced imaging, or even outpatient procedures.

The federal government sets certain guidelines, but plan structures and service areas vary dramatically. Even plans with the same name can offer different benefits in different counties.

Annual Changes Make Perk-Based Decisions Risky

Every year during Medicare Open Enrollment (October 15 to December 7), plans can and do change their benefits. That includes the extras. The gym membership or OTC allowance that attracted you this year might not be there the next.

By law, plans must notify you about changes in an Annual Notice of Change (ANOC) document sent by September. But if you chose your plan based on perks alone, and those perks vanish, you may find yourself locked into a plan that doesn’t serve your medical needs well.

Unless you qualify for a Special Enrollment Period, you typically can’t switch again until the next enrollment window.

How to Evaluate Plans the Smart Way

Instead of focusing on perks first, reverse your evaluation process:

1. Start with your doctors and hospitals: Are they in the plan’s network?

2. Check coverage rules: Does the plan require referrals or pre-approvals for common services?

3. Compare prescription coverage: Is your medication covered? What tier is it on?

4. Review cost structure: Look at deductibles, copays, coinsurance, and out-of-pocket maximums.

5. Then, consider the perks: Do they add value after you’ve verified the medical essentials?

This approach ensures the plan works for your actual healthcare needs before rewarding you with extras.

Special Considerations for 2025

Several regulatory and structural updates affect Medicare Advantage this year:

• The new Part D out-of-pocket cap is $2,000, making drug costs more predictable.

• Mid-year notifications now alert you to unused supplemental benefits between June 30 and July 31, encouraging better usage.

• Some supplemental benefits like transportation and OTC allowances are being scaled back in certain areas, based on provider data.

These updates mean you may need to read plan documents even more carefully than before. What looked like a benefit in 2024 might be gone or reduced in 2025.

What to Watch for in the Plan Documents

Plan documents can be long and filled with industry terms, but here’s where to look:

• Summary of Benefits: Shows copays, extra services, and coverage limits.

• Evidence of Coverage (EOC): Explains in detail how the plan works, including prior authorizations.

• Drug formulary: Lists medications and what you’ll pay at different tiers.

• ANOC (Annual Notice of Change): Outlines what changed from the previous year.

Take time to review these carefully. If anything seems unclear, don’t guess. A licensed agent can help you understand what it means in your situation.

Why Medicare Advantage Isn’t Always the Best Fit

Medicare Advantage may look like an all-in-one solution, especially with the extra perks. But if you:

• Travel often or spend time in multiple states

• See specialists who are out-of-network

• Have chronic conditions requiring frequent care

…you may find Original Medicare combined with a Medigap plan offers more flexibility, even without perks. Medigap plans help pay for what Original Medicare doesn’t cover, and many don’t require referrals or limit your provider access. But remember, these plans have their own rules and don’t offer routine extras like dental or vision.

It’s about prioritizing what matters most: your long-term access to care, not short-term bonuses.

Making Informed Decisions in the Face of Tempting Marketing

Marketing for Medicare Advantage plans is designed to influence you emotionally. Colorful mailers, upbeat commercials, and celebrity endorsements don’t highlight network restrictions, pre-approvals, or benefit caps. They spotlight the perks.

To protect yourself, evaluate every plan as if you were already sick. Ask:

• Would I be able to see my preferred doctor?

• What would I pay if I needed surgery or specialist care?

• Are there hurdles to getting approval for treatment?

Only after those questions are answered should you ask about free rides or dental cleanings.

You Deserve Coverage That Works When You Need It Most

Choosing a Medicare Advantage plan should never be about who gives the flashiest perks. It should be about whether the plan protects you in the hospital, at the pharmacy, and during recovery. That’s where the real value lies.

If you’re unsure how to compare plans, need help understanding network rules, or want to know if a plan fits your prescriptions and providers, reach out to a licensed agent listed on this website. A short conversation now can help you avoid long-term frustration later.