Medicare Advantage (Part C)

What Is Medicare Advantage?

Medicare Advantage (Part C) is a Medicare-approved plan offered by private insurance companies as an alternative to Original Medicare. These bundled plans must cover everything Original Medicare covers — and most include Part D prescription drug coverage as well. Many plans also offer benefits that go well beyond what Original Medicare provides.

What's Typically Included

Part A (Hospital Insurance)
Part B (Medical Insurance)
Part D (Prescription Drug Coverage) — in most plans
Dental care (exams, cleanings, X-rays)
Vision coverage (eye exams, glasses or contacts)
Hearing benefits (hearing tests, hearing aids)
Fitness memberships and wellness programs
Transportation to medical appointments (some plans)
Over-the-counter item allowances (some plans)

How It Differs from Original Medicare

With Original Medicare, you can generally see any provider who accepts Medicare nationwide. Medicare Advantage plans often use networks — HMOs typically require referrals and in-network providers, while PPOs offer more flexibility at higher cost-sharing. Out-of-pocket expenses differ as well: Advantage plans set their own deductibles and copays, but all plans are required to cap your annual out-of-pocket costs, which Original Medicare does not do.

Plan Types at a Glance

HMO (Health Maintenance Organization) — Lower premiums, in-network care required, referrals usually needed for specialists.
PPO (Preferred Provider Organization) — More provider flexibility, higher cost-sharing for out-of-network care, no referrals needed.
PFFS (Private Fee-for-Service) — Sets its own payment terms; not all providers will accept the plan.
MSA (Medical Savings Account) — High-deductible plan paired with a Medicare-funded savings account.
SNP (Special Needs Plan) — Tailored for people with specific conditions or eligibility (see D-SNP and C-SNP pages).

Costs

Many Medicare Advantage plans have a $0 monthly premium — you still pay your Part B premium, but the plan itself costs nothing additional. Other plans charge a premium in exchange for richer benefits or broader networks. You'll also encounter plan-specific deductibles, copays, and coinsurance. Every plan sets an annual out-of-pocket maximum; once you hit it, covered services cost nothing for the rest of the year.

💡 Important: You must continue paying your Medicare Part B premium even when enrolled in a Medicare Advantage plan.

Enrollment Requirements & Periods

To join a Medicare Advantage plan you must have both Part A and Part B, and live in the plan's service area. You can enroll during your Initial Coverage Election Period (when you first become eligible for Medicare), the Annual Enrollment Period (October 15 – December 7), or a Special Enrollment Period if you qualify due to specific life circumstances.

Is Medicare Advantage Right for You?

Medicare Advantage can be an excellent fit if you want the convenience of one plan, value extra benefits like dental and vision, and prefer predictable out-of-pocket costs. It's worth carefully weighing network restrictions and comparing total costs — including premiums, copays, and potential out-of-network exposure — against Medigap alternatives. We'll help you do that analysis.

Medicare Advantage(Part C)