Key Takeaways

• Medicare Advantage plans offer many attractive features, but it’s essential to understand what you’re actually getting—and what may come with restrictions or conditions.

• Benefits like dental, vision, gym memberships, and over-the-counter allowances sound appealing but often come with limitations that vary widely by plan.

The Big Promises in Medicare Advantage

Medicare Advantage, or Medicare Part C, is often marketed as a convenient all-in-one alternative to Original Medicare. In 2025, over half of Medicare beneficiaries are enrolled in an Advantage plan, drawn by bundled features and the potential for additional benefits not covered under Original Medicare.

While these plans are approved by Medicare, they are offered through private companies. That means the coverage details, network restrictions, and out-of-pocket costs can differ significantly. Many of the features that seem like clear wins deserve a closer look before you make a commitment.

Dental, Vision, and Hearing: Covered—But How?

One of the biggest draws to Medicare Advantage is the inclusion of dental, vision, and hearing benefits. Original Medicare typically doesn’t cover these services, so the idea of getting them included sounds like a major upgrade.

But here’s the catch:

• Dental coverage may be limited to preventive care only, such as cleanings and X-rays. More extensive procedures like crowns or root canals could be partially covered—or not covered at all.

• Vision benefits might only include an annual eye exam and an allowance for glasses or contacts. That allowance often comes with a dollar limit, which might not fully cover brand-name frames or lenses.

• Hearing coverage frequently includes exams and some coverage toward hearing aids, but again, there may be a cap that leaves you with substantial out-of-pocket expenses.

In short, you might be covered—but only to a point. Always check what procedures and services are included, the annual limits, and whether you can use your own provider.

Over-the-Counter Allowances and Grocery Cards

Some Advantage plans in 2025 include quarterly or monthly allowances for over-the-counter (OTC) items like pain relievers, vitamins, and first-aid supplies. Others may offer grocery cards for eligible beneficiaries based on certain health conditions.

These sound like fantastic extras, but they can come with restrictions:

• You may have to order OTC products through a designated catalog or website.

• Items might be limited to specific brands or categories.

• The allowances may expire at the end of each benefit period and cannot be rolled over.

• Grocery cards are typically available only to individuals with chronic health conditions that meet eligibility criteria.

These features are useful—but only if you understand how they work and whether you qualify.

Fitness Benefits Aren’t One-Size-Fits-All

Gym memberships through programs like SilverSneakers or other wellness offerings are often included in Advantage plans. While staying active is vital for good health, the fine print on these memberships matters.

• Not all gyms participate in the program.

• Coverage may only include basic memberships and not specialty classes or services.

• If you live in a rural area, your access to participating facilities may be limited.

Make sure to verify which fitness centers are included near you and what services you can actually use.

Telehealth: Convenient, but Not Always Complete

Telehealth became more prominent during the COVID-19 pandemic and remains a feature in many Medicare Advantage plans in 2025. These services can include virtual visits with primary care providers, mental health professionals, and specialists.

However:

• Certain procedures or consultations still require in-person visits.

• Not all types of specialists offer virtual appointments.

• The quality of care may vary based on internet access, digital literacy, and the provider’s platform.

Telehealth is a useful tool but not a replacement for all types of care.

Networks and Referrals Still Apply

Unlike Original Medicare, many Medicare Advantage plans are built around a provider network. This is a fundamental feature that can impact your access to care.

• You may need to choose a primary care physician (PCP).

• Referrals might be required for specialists.

• Care received outside of your plan’s network may not be covered—or may come with higher out-of-pocket costs.

This can especially affect snowbirds, frequent travelers, or people who live in one state part of the year and another state the rest of the time. While some plans offer travel benefits or nationwide networks, not all do. Read the details carefully.

Prescription Drug Coverage Varies

Most Medicare Advantage plans include prescription drug coverage (Part D). But unlike standalone Part D plans, these bundled versions can vary greatly.

• Drug formularies are not standardized. Medications covered by one plan might not be covered by another.

• Costs can differ, including copayments and coinsurance.

• Pharmacies in-network may be limited depending on where you live.

In 2025, a major improvement is the introduction of a $2,000 annual cap on out-of-pocket drug costs. While this is a big step forward, how quickly you reach that cap depends on the plan’s tier structure and cost-sharing setup.

Out-of-Pocket Maximums: Protection with a Price

One strength of Medicare Advantage is that all plans must have an annual out-of-pocket maximum for in-network services. In 2025, this limit is $9,350 for in-network care and $14,000 for combined in- and out-of-network services.

While this can offer financial protection, keep in mind:

• High deductibles or coinsurance could accelerate how quickly you reach that limit.

• Not all services count toward the out-of-pocket max (for example, non-Medicare covered services like cosmetic procedures).

• Premiums, even though not discussed here, are separate from this limit and still apply.

The maximum acts as a ceiling, but the floor—what you pay up front—can be uneven.

Supplemental Benefits: Great on Paper

In 2025, supplemental benefits such as meal delivery, transportation to medical appointments, or home modifications for safety are offered by many Advantage plans. These are especially geared toward individuals with chronic conditions or functional limitations.

However:

• Access to these benefits may require meeting specific clinical eligibility.

• There may be limits on how many times you can use the service each year.

• Some services may require prior authorization.

These features can improve quality of life—but they aren’t automatically available to everyone in the plan.

Enrollment and Plan Changes: Time Windows Matter

Enrollment in Medicare Advantage is time-sensitive. Here are the main windows to be aware of in 2025:

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday.

• Annual Enrollment Period (AEP): October 15 to December 7—when you can switch, drop, or join a plan.

• Medicare Advantage Open Enrollment (MA OEP): January 1 to March 31—if you’re already enrolled in a Medicare Advantage plan, you can switch to another or return to Original Medicare.

• Special Enrollment Periods (SEP): Triggered by life changes, such as moving, losing coverage, or becoming eligible for extra help.

Missing these deadlines could mean staying in a plan that no longer fits your needs.

What to Do Before You Enroll

Before signing up for a Medicare Advantage plan, take the following steps:

• Compare plans carefully. Don’t just go with the one that has the most benefits—check what’s actually covered.

• Verify provider participation. Make sure your doctors and hospitals are in-network.

• Review drug coverage. Confirm that your prescriptions are on the plan’s formulary.

• Understand cost-sharing. Look at deductibles, copayments, and how close you might come to reaching the out-of-pocket maximum.

• Ask about benefit limitations. Especially for supplemental benefits, get clarity on eligibility and restrictions.

Doing your homework now could prevent expensive surprises later.

The Features Are Real—But So Are the Trade-Offs

Medicare Advantage plans in 2025 do offer many attractive features. But those benefits often come with conditions, limitations, or extra rules that can affect your experience with care.

If you’re unsure about whether a plan is right for you, reach out to a licensed insurance agent listed on this website. They can walk you through the fine print and help you make an informed choice based on your health needs and lifestyle.