Medicare Advantage · Part C
Medicare Advantage, explained simply.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They cover everything Parts A and B cover, usually add drug coverage, and limit what you pay each year for in-network care.
- Hospital and medical in one plan
- Most include Part D drug coverage
- A yearly out-of-pocket limit
The basics
How Medicare Advantage works
With Medicare Advantage, also called Part C, you still have Medicare, but a private plan pays your claims instead of Original Medicare. You keep paying your Part B premium, and some plans charge an additional premium.
Most plans use a network of doctors and hospitals. In exchange, they often offer lower costs when you use network providers, plus benefits Original Medicare doesn’t cover.
Every plan must cover what Original Medicare covers. If you need hospice care, Original Medicare still covers it.
Plan types
HMO, PPO or Special Needs Plan?
HMO
You generally use doctors and hospitals in the plan’s network and may need a referral to see a specialist. Premiums are often the lowest.
PPO
You can see out-of-network doctors, usually at a higher cost. Most specialists don’t require a referral.
Special Needs Plan (SNP)
Built for people with Medicaid (D-SNP), certain chronic conditions (C-SNP), or who live in a nursing home (I-SNP).
About dual plans →
Beyond Original Medicare
Benefits many plans include
Prescription drugs
Most Advantage plans include Part D drug coverage in the same plan.
Dental, vision and hearing
Routine cleanings, eyeglasses and hearing aids are common extras.
Fitness programs
Many plans include gym memberships or at-home fitness programs.
Over-the-counter allowance
Some plans give a credit for health and wellness products.
Transportation
Some plans include rides to medical appointments.
Telehealth
Virtual visits with doctors, often at a low or $0 copay.
Extra benefits vary by plan and area, and some are only for members who qualify.
Is it right for you?
When Medicare Advantage tends to fit
May fit well if you…
- Want hospital, medical and drug coverage in one plan
- Are comfortable using a provider network
- Want a cap on your yearly out-of-pocket costs
- Value extras like dental, vision and hearing
Think twice if you…
- Spend long stretches outside your plan’s area
- Want to see any doctor nationwide who accepts Medicare
- Prefer predictable costs with few copays
- Rely on a doctor or hospital that isn’t in local networks
Examples, not recommendations. The right choice depends on your doctors, prescriptions, health and budget.
Before you enroll
What we check for you
- 1.Every doctor and hospital you use is in the network
- 2.Each prescription is on the formulary, and at what tier
- 3.Referral and prior authorization rules
- 4.The out-of-pocket limit and copays for the care you use
- 5.Whether your pharmacy is in network or preferred
- 6.The plan’s Medicare star rating
FAQ
Common questions
Do I still pay my Part B premium with Medicare Advantage?
Yes. You keep paying your Part B premium unless Medicaid or a Medicare Savings Program pays it for you. Some plans charge their own premium as well, and a few reduce your Part B premium.
Can I keep my doctor?
Only if your doctor is in the plan’s network, or the plan is a PPO that covers out-of-network care. We check every provider before you enroll.
What is the maximum out-of-pocket limit?
It’s the most you’ll pay in a year for covered services. For 2027, Medicare caps in-network costs at $9,850, and $14,800 for in- and out-of-network care combined. Many plans set lower limits.
Can I switch from Medicare Advantage back to Original Medicare?
Yes, during Annual Enrollment or Medicare Advantage Open Enrollment. In most states you may have to answer health questions to buy a Medigap policy later. In New York, Medigap insurers must accept applicants year-round.
Am I covered when I travel?
Every plan covers emergency and urgent care anywhere in the U.S. Routine care outside your plan’s service area usually isn’t covered unless the plan has a travel benefit.
See Advantage plans in your area.
We’ll check your doctors and prescriptions against each plan before you decide.