What Is Medicare Advantage (Part C)?

Understanding Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan offered by private companies that contract with Medicare to provide all your Part A (hospital) and Part B (medical) benefits. Most Medicare Advantage plans also include Part D prescription drug coverage, and many offer additional benefits that Original Medicare does not cover, such as dental, vision, hearing, and fitness programs.

When you join a Medicare Advantage plan, you are still enrolled in Medicare. The federal government pays the private insurance company a fixed amount per month to provide your care. In return, the insurance company must cover everything that Original Medicare covers, though they may use different rules, costs, and coverage restrictions.

How Medicare Advantage Plans Work

Medicare Advantage plans work differently from Original Medicare in several important ways. Most plans use provider networks, meaning you may need to use doctors, hospitals, and other healthcare providers that belong to the plan's network. The two most common network types are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).

With an HMO plan, you generally must use in-network providers except in emergencies. With a PPO plan, you can see out-of-network providers but will pay more for that flexibility. Some plans may also require referrals to see specialists.

Medicare Advantage plans have annual out-of-pocket maximums, which Original Medicare does not have. Once you reach this limit, the plan pays 100% of covered services for the rest of the year. This cap provides important financial protection against catastrophic healthcare costs.

What Medicare Advantage Plans Cover

All Medicare Advantage plans must cover the same services as Original Medicare Part A and Part B. This includes hospital stays, doctor visits, lab tests, preventive care, durable medical equipment, and more.

Beyond these required benefits, most Medicare Advantage plans also include:

• Prescription drug coverage (Part D)
• Dental care (routine cleanings, X-rays, sometimes major dental work)
• Vision care (eye exams, eyeglasses or contacts)
• Hearing services (hearing exams, hearing aids)
• Fitness programs (SilverSneakers, Renew Active)
• Over-the-counter allowances for health products
• Transportation to medical appointments
• Telehealth and virtual care visits
• Wellness programs and chronic disease management

The specific additional benefits vary by plan and change annually. Some plans offer more generous extra benefits as incentives to enroll.

Medicare Advantage Costs

Medicare Advantage plans have several cost components to consider. First, you must continue paying your Medicare Part B premium (the standard amount is $185 per month in 2026). In addition, many Medicare Advantage plans charge their own monthly premium, though a significant number of plans have $0 monthly premiums.

Other costs include copayments for doctor visits and services, coinsurance for certain procedures, and deductibles. These cost-sharing amounts vary by plan and are outlined in each plan's Summary of Benefits.

The annual out-of-pocket maximum for Medicare Advantage plans is capped by Medicare. For 2026, the maximum out-of-pocket limit for in-network services cannot exceed $8,850. Many plans set their limits lower than this maximum.

Is Medicare Advantage Right for You?

Medicare Advantage may be a good choice if you want an all-in-one plan that combines medical, drug, and extra benefits with a predictable out-of-pocket maximum. Plans with $0 premiums can be particularly attractive for budget-conscious beneficiaries.

However, Medicare Advantage may not be ideal if you travel frequently and want to see doctors nationwide without network restrictions, if you have established relationships with providers who are not in any MA plan networks, or if you prefer the freedom to see any Medicare-accepting provider without referrals.

Consider your healthcare needs, preferred doctors, prescription medications, budget, and lifestyle when deciding between Medicare Advantage and Original Medicare with a Medigap supplement policy.