What are Medicare Advantage plans (Medicare Part C)?

Medicare Advantage plans, also called Medicare Part C, are an all-in-one health insurance option instead of Original Medicare. Medicare Advantage combines hospital care, doctor visits, and often prescription drug coverage into one simple plan. Most plans also include additional benefits such as dental, vision, and hearing.

According to the Kaiser Family Foundation (KFF), 35 million people, 55% of all eligible Medicare beneficiaries, are now enrolled in Medicare Advantage as of 2026. In this guide, you’ll learn how these plans work, what they cost, and how to enroll.

What Are Medicare Advantage Plans?

Medicare Advantage plans, sometimes called Part C or MA plans, are an alternative way to get your Medicare coverage. Private insurance companies offer these plans and must follow rules set by Medicare.

These plans include Medicare Part A (hospital insurance) and Part B (medical insurance), and most also include Part D prescription drug coverage. According to Medicare.gov, Medicare Advantage plans must cover at least the same services as Original Medicare.

One key difference of Medicare Advantage plans is cost protection. Original Medicare does not have a yearly limit on what you pay out of pocket. Medicare Advantage plans do. 

Once you reach that limit, the plan pays 100% of the cost for covered services for the rest of the year. The Centers for Medicare & Medicaid Services requires all Medicare Advantage plans to include a yearly out-of-pocket maximum.

Agent tip:

Medicare Advantage plans must cover at least the same services as Original Medicare Parts A and B. Extra benefits, such as dental, vision, and hearing, vary by plan and location. Always review the full benefits, not just the monthly premium, before you enroll.

What Does Medicare Advantage Cover? 

All Medicare Advantage plans must cover the same services as Original Medicare. But most plans go further and include:

• Dental care (cleanings, X-rays, and sometimes major dental work)
• Vision exams and glasses
• Hearing tests and hearing aids
• Fitness memberships or wellness programs
• Over-the-counter (OTC) allowances for everyday health products
• Transportation to doctor visits

HMO vs. PPO: What’s the Difference?

Most Medicare Advantage plans are either HMOs or PPOs. Understanding the difference helps you choose the right plan.

HMO (Health Maintenance Organization)

With an HMO, you must use doctors and hospitals that accept Medicare and are in the plan’s network to treat your health conditions. You also need a referral from your primary care doctor to see a specialist. HMOs tend to have lower cost sharing, but less flexibility.

PPO (Preferred Provider Organization)

With a PPO, you can see any doctor, in or out of the network, without a referral. Staying in-network costs less, but you’re not required to do so. PPOs offer more flexibility, often at a higher cost.

How Much Does Medicare Advantage Cost?

In 2026, Medicare Advantage plans can charge no more than $9,250 per year for in-network services and $13,900 for combined in-network and out-of-network services, according to KFF. 

The average enrollee faces an in-network limit of $5,421. About 1 in 8 enrollees (13%) are in plans with limits of $3,000 or less, but nearly 1 in 5 (19%) face limits above $7,000. This is why it pays to compare plans carefully, not just look at the premium. Here are the main costs to know:

Monthly Premium

Many Medicare Advantage plans have a $0 monthly premium. That means you only pay your Medicare Part B premium. Some plans with extra benefits may have a monthly cost. Prices vary by plan and location.

Copays and Coinsurance

You pay a set amount (copay) or a percentage (coinsurance) when you use services. Some plans charge $0 for a visit to your primary care doctor or specialist.

Deductible

Some plans have a deductible, the amount you pay before coverage kicks in. Many plans have no deductible.

Out-of-Pocket Maximum

This is the most you will pay for covered services in a plan year. After you hit this limit, your plan covers 100% of costs for the rest of the year. Original Medicare has no such limit.

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Does Medicare Advantage Include Drug Coverage?

Most Medicare Advantage plans include prescription drug coverage (Part D). These are called MAPD plans (Medicare Advantage Prescription Drug plans). Some plans, such as Medicare Cost Plans and certain Special Needs Plans, do not include drug coverage. If yours doesn’t, you can add a stand-alone Part D plan.

Who Can Join a Medicare Advantage Plan?

You can join a Medicare Advantage (Part C) plan if you:

• Are eligible for Medicare and enrolled in both Medicare Part A and Part B
• Live in the plan’s service area
• Do not have End-Stage Renal Disease (ESRD), though most plans now accept ESRD enrollees

Plans are available by county. The options in your area depend on where you live.

When Can You Enroll?

You can enroll in Medicare Advantage during your Initial Enrollment Period, Annual Enrollment Period, or a Special Enrollment Period.

Initial Enrollment Period (IEP)

The Initial Enrollment Period is the best time to enroll. It starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after that month. That’s a 7-month window.

Annual Enrollment Period (AEP)

The Annual Enrollment Period takes place from October 15 through December 7 each year. This is when you can switch, join, or drop a Medicare Advantage plan. New coverage starts January 1.

Special Enrollment Period (SEP)

You may qualify for a Special Enrollment Period if you have a life event such as losing employer coverage, moving out of your plan’s service area, or qualifying for a low-income program.

Bottom Line

Medicare Advantage plans offer a convenient, often low-cost way to get your Medicare coverage. They bundle hospital, medical, and usually drug benefits into one plan. The right plan depends on your doctors, your prescriptions, and your budget. A licensed insurance agent can help you compare all your options at no cost.

Need Help Deciding The Right Medicare Coverage For You?

• No-cost, unbiased service
• Compare all major plans and carriers
• Local, licensed insurance agents with 25+ years of combined experience

Call Now Compare Plans

Frequently Asked Questions

Can I keep my doctor if I switch to Medicare Advantage?

It depends on the plan you choose. HMO plans require you to use in-network doctors. PPO plans let you see out-of-network doctors, but at a higher cost. 

What happens if I travel and need care while on a Medicare Advantage plan?

Most HMO plans only cover emergency or urgent care outside your network. PPO plans offer more flexibility for out-of-network care while traveling.

What is a Medicare Advantage star rating?

The Centers for Medicare & Medicaid Services rates Medicare Advantage plans on a 1- to 5-star scale each year. Ratings reflect quality of care, customer service, and member experience. 

Can I switch Medicare Advantage plans every year?

Yes. During the Annual Enrollment Period (October 15 – December 7), you can switch plans, drop your plan, or go back to Original Medicare.

Does Medicare Advantage cover care in a skilled nursing facility?

Yes, Medicare Advantage plans cover skilled nursing facility (SNF) care, just like Original Medicare.