What Is Medicare Advantage?
Medicare Advantage (Part C) is an alternative way to get your Medicare benefits. Instead of getting Parts A and B directly from the federal government, you get them through a private insurance company that contracts with Medicare.
Most Medicare Advantage plans also include Part D (drug coverage) and extras like dental, vision, and hearing that Original Medicare doesn’t cover.
How It Works
- You still pay your Part B premium to Medicare
- You may pay an additional premium to the plan (many plans have $0 additional premium)
- The plan has its own network of doctors and hospitals
- You follow the plan’s rules: copays, prior authorizations, referrals (for HMOs)
- There’s an annual maximum out-of-pocket limit (MOOP) that caps your costs
Plan Types
HMO (Health Maintenance Organization)
Most common type. You must use in-network providers (except emergencies). You usually need a referral from your primary care doctor to see a specialist.
PPO (Preferred Provider Organization)
You can see out-of-network providers, but you’ll pay more. No referral needed for specialists. Generally more expensive than HMOs.
Special Needs Plans (SNPs)
Designed for people with specific conditions, income levels, or living situations. Dual-Eligible SNPs (D-SNPs) are for people who have both Medicare and Medicaid.
The Trade-offs
What you gain:
- Often lower monthly premiums (some plans are $0 beyond your Part B premium)
- Dental, vision, and hearing coverage built in
- Drug coverage included (usually)
- Maximum out-of-pocket limit caps your costs for the year
- Some plans offer extras like gym memberships, meal delivery, or transportation
What you give up:
- Freedom to see any Medicare-accepting doctor. You’re limited to a network.
- Prior authorization. The plan can require approval before certain services.
- Geographic restrictions. HMO plans typically don’t cover you outside the service area except for emergencies.
- Switching costs. If you want to go back to Original Medicare later, you may not be able to get a Medigap plan at standard rates (depends on your state and health).
The “$0 Premium” Reality
Many Medicare Advantage plans advertise $0 premiums. This means $0 beyond your Part B premium. You still pay your Part B premium ($202.90/month in 2026).
The $0 premium doesn’t mean $0 cost. You’ll pay copays and coinsurance when you use services. The question is whether your total annual costs (premiums + copays + drug costs) end up higher or lower than the Medigap path.
For healthy people who rarely use healthcare, Medicare Advantage can be cheaper. For people who use a lot of healthcare, the copays can add up fast.
Choosing a Plan
Medicare Advantage plans vary significantly by location. A 5-star plan in one county might not be available in the next county over. When evaluating plans, look at:
- Network: Are your current doctors in the plan’s network?
- Drug formulary: Are your medications covered? At what tier?
- MOOP: What’s the maximum you could pay out of pocket in a year?
- Prior authorization: How aggressively does the plan gate services?
- Star rating: CMS rates plans 1-5 stars based on quality measures
Not sure which path makes sense for you? See our full comparison for a side-by-side breakdown.