What is Medicare Advantage?
Medicare Advantage (also called Part C or "MA plans") is a way to get your Medicare Part A and Part B benefits through a private insurance company that contracts with Medicare. Instead of Original Medicare paying your claims, the plan does. Every Medicare Advantage plan must cover all medically necessary services that Original Medicare covers — except hospice care, which Original Medicare still covers even if you're in a Medicare Advantage plan.
Most Medicare Advantage plans also include Part D prescription drug coverage (these are called MA-PD plans), and many add benefits Original Medicare doesn't cover, such as routine vision, hearing, dental and fitness programs. Each plan sets its own premiums, deductibles, copays and network rules, and those can change every January 1.
Joining a Medicare Advantage plan does not replace your Part B premium. In 2026 the standard Part B premium is $202.90 per month. Some plans charge an additional premium; others have a $0 plan premium.
Who can join?
- You have Medicare Part A and Part B.
- You live in the plan's service area.
- You are a U.S. citizen or lawfully present in the United States.
People with End-Stage Renal Disease (ESRD) can also join a Medicare Advantage plan. You can't have a Medicare Advantage plan and a Medigap policy work together — Medigap policies only pay cost-sharing for Original Medicare.
Types of Medicare Advantage plans
| Plan type | How it works | Out-of-network care |
|---|---|---|
| HMO Health Maintenance Organization | You generally use doctors and hospitals in the plan's network and may need a referral to see a specialist. | Usually not covered except emergencies, urgent care and out-of-area dialysis. |
| PPO Preferred Provider Organization | A network of preferred providers with lower costs; referrals usually not required. | Covered, typically at a higher cost. |
| PFFS Private Fee-for-Service | The plan sets how much it pays providers and how much you pay. Providers decide whether to accept the plan's terms. | Any Medicare-approved provider who agrees to the plan's terms. |
| SNP Special Needs Plan | Benefits and networks tailored to people with Medicare and Medicaid (D-SNP), certain chronic conditions (C-SNP) or who live in an institution (I-SNP). | Depends on the plan; most work like HMOs. |
| MSA Medical Savings Account | A high-deductible plan paired with a bank account the plan deposits money into for health costs. | Any provider; no drug coverage included. |
The yearly out-of-pocket limit
Original Medicare has no cap on what you can spend on Part A and Part B cost-sharing. Medicare Advantage plans do: every plan sets a maximum out-of-pocket (MOOP) amount for covered Part A and Part B services. Once you reach it, the plan pays 100% of covered services for the rest of the calendar year. PPO plans usually have one limit for in-network care and a higher combined limit for in- and out-of-network care. Premiums and prescription drug costs don't count toward the MOOP.
Extra benefits — what to know
Many Medicare Advantage plans include benefits beyond Original Medicare, for example routine eye exams and eyewear allowances, hearing exams and hearing aids, preventive and comprehensive dental care, fitness memberships, over-the-counter allowances and transportation to medical appointments. These benefits vary by plan and by county, may have limits and network rules, and some are only available to people who meet specific eligibility criteria. Ask your agent to show you the plan's Evidence of Coverage for the exact details.
Pros and trade-offs
Often appealing
- All-in-one coverage, often with drugs
- Yearly out-of-pocket maximum
- Plans with $0 premiums available in many areas
- Extra benefits like dental, vision and hearing
Worth weighing
- Provider networks and prior authorization
- Copays add up if you need frequent care
- Coverage generally limited when traveling
- Benefits and networks can change yearly
When can I join or switch?
You can join a Medicare Advantage plan when you first become eligible (your Initial Enrollment Period), during Open Enrollment from October 15 to December 7, and during the Medicare Advantage Open Enrollment Period from January 1 to March 31 if you're already in a Medicare Advantage plan. Certain life events qualify you for a Special Enrollment Period. See every enrollment window →
Frequently asked
Is a $0 premium plan really free?
A $0 premium means the plan itself charges no monthly premium. You still pay your Part B premium, and you will have copays, coinsurance and possibly deductibles when you use care.
What happens if my doctor leaves the network?
Plans must notify you, and in some cases you may qualify for a Special Enrollment Period. Your agent can help you review options.
Can I go back to Original Medicare?
Yes — during Open Enrollment (Oct 15 – Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31). Note that buying a Medigap policy later may require medical underwriting in many states.