Medicare Learning Center

What Is Medicare Advantage (Part C)?

Medicare Advantage plans replace Original Medicare with a single private plan that covers hospital, medical, and usually prescription drug benefits. According to KFF, 33.8 million Americans, about 54% of all Medicare beneficiaries, are enrolled in Advantage plans as of 2026. Most plans have $0 monthly premiums but require using a provider network.

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How Does Medicare Advantage Work?

Medicare Advantage (Part C) plans are offered by private insurance companies as an alternative to Original Medicare. They must cover everything Parts A & B cover, and most plans also include Part D drug coverage plus extras like dental, vision, hearing, and fitness benefits. According to CMS, the average Medicare Advantage enrollee has access to 43 plans in their area.

The tradeoff: most Advantage plans use provider networks (HMO or PPO), meaning you may be limited in which doctors and hospitals you can use. You also typically face copays, coinsurance, and deductibles when you receive care. The maximum out-of-pocket limit for in-network services is $8,300 in 2026.

You must continue paying your Part B premium ($202.90/month in 2026) in addition to any Advantage plan premium. Many plans have $0 premiums, but that doesn't mean $0 costs, you pay when you use care.

What Types of Medicare Advantage Plans Are Available?

HMO

Most common type (62% of enrollees). Requires a primary care physician and referrals for specialists. No out-of-network coverage except emergencies. Usually the lowest premiums.

PPO

More flexibility - see out-of-network providers at higher cost. No referrals needed. About 30% of Advantage enrollees choose PPO plans.

HMO-POS

Like an HMO but allows some out-of-network coverage at higher cost. A middle ground between HMO and PPO.

PFFS

Private Fee-for-Service plans let you see any Medicare-accepting provider. Less common and availability varies by area.

SNP

Special Needs Plans are designed for people with specific chronic conditions, dual Medicare/Medicaid eligibility, or institutional care needs.

MSA

Medical Savings Account plans pair a high-deductible plan with a savings account. Medicare deposits money into the account for you to use toward care.

What Are the Pros and Cons of Medicare Advantage?

Advantages

• Lower or $0 monthly premiums
• Often includes dental, vision, and hearing
• Drug coverage usually included
• Out-of-pocket maximum protects you ($8,300 max in 2026)
• May include fitness benefits and transportation

Considerations

• Network restrictions - limited doctor choice
• May need referrals for specialists (HMO)
• Higher costs when you actually use care
• Coverage limited to plan's service area
• Prior authorization may be required for some services

Frequently Asked Questions About Medicare Advantage

Medicare Advantage is an alternative to Original Medicare offered by private insurance companies. It bundles Parts A, B, and usually D into one plan, often with extra benefits like dental, vision, and hearing. About 54% of new Medicare enrollees choose Advantage plans, according to KFF.

Most Medicare Advantage plans have $0 monthly premiums (beyond the $202.90 Part B premium you must still pay). However, you pay copays and coinsurance when you use care. The maximum out-of-pocket limit is $8,300 per year in 2026.

Usually not. Most plans use HMO or PPO networks. HMO plans require in-network doctors and referrals for specialists. PPO plans allow some out-of-network use at higher cost. Always verify your doctors are in-network before enrolling.

Most Medicare Advantage plans include Part D drug coverage at no extra premium. However, each plan has its own formulary (list of covered drugs), so check that your specific medications are covered before enrolling.

Yes. During the Annual Enrollment Period (October 15, December 7), you can switch back to Original Medicare. You can also switch during the Medicare Advantage Open Enrollment Period (January 1, March 31). However, getting a Medicare Supplement plan after leaving Advantage may require medical underwriting.

Generally no. Most plans limit coverage to a specific service area. If you travel frequently or split time between states, a Medicare Supplement plan with Original Medicare provides nationwide coverage with any Medicare-accepting doctor.

Sources: CMS.gov, KFF.org

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