Medicare Advantage · Part C
Plain English. Five calm steps. No pressure.
Medicare Advantage is a way to get your Medicare benefits through a private insurance company, usually in one plan. It works well for many people — and it isn't right for everyone. Here's how to tell which it is for you.
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Your Medicare Advantage Path
Read them in order, or jump straight to what you need.
How Medicare Advantage works, and who can join.
HMO, PPO and Special Needs Plans, explained.
How it compares to Original Medicare with a Medigap plan.
Your enrollment windows — and your right to change your mind.
A checklist, then enroll yourself when you're ready.
Step 1 What It Is
Medicare Advantage = Part C
When you join a Medicare Advantage plan, a private insurance company approved by Medicare provides your hospital and medical coverage instead of Original Medicare. You're still in Medicare — with all the same rights and protections — but you use the plan's card, rules and costs.
Hospital stays, doctor visits, outpatient care and preventive services — every plan must cover these.
Most plans include Part D prescription coverage, so you don't need a separate drug plan.
Many plans include some dental, vision, hearing or fitness benefits that Original Medicare doesn't cover. What's included varies by plan.
Varies by planOnce you've paid a set amount for covered medical care in a year, the plan pays 100% for the rest of the year.
To join a Medicare Advantage plan, you must:
Step 2 Plan Types
Not All Medicare Advantage Plans Work the Same Way
The biggest difference between plan types is how much freedom you have to see doctors outside the plan's network — and what that freedom costs.
Health Maintenance Organization. You generally use the plan's network and choose a primary care doctor. You usually need a referral to see a specialist. Out-of-network care usually isn't covered, except emergencies.
Lower cost · Less flexibility
Preferred Provider Organization. You pay less in the network, but you can also go out of network for covered care at a higher cost. Referrals usually aren't required.
More flexibility · Often higher cost
Designed for people with both Medicare and Medicaid, certain chronic conditions like diabetes or heart failure, or who live in a nursing home. Benefits and care are tailored to those needs.
Must qualify to join
Also good to know: some areas have other plan types, such as Private Fee-for-Service (PFFS) plans or Medical Savings Account (MSA) plans. They're less common and work differently — read the plan's details carefully before you join.
Traveling or living part of the year elsewhere? Every plan covers emergency and urgent care anywhere in the U.S. But most plans don't cover routine care outside the plan's service area. If you spend months in another state, check this before you choose.
Step 3 Costs & Trade-Offs
There's No Single "Best" Choice
With Medicare Advantage, you usually pay less each month and more when you use care, through copays and coinsurance. Here are the 2027 limits Medicare sets on how much a plan can make you pay in a year:
2026 limits were $9,250 in-network and $13,900 combined. Source: CMS contract year 2027 standards for Medicare Advantage plans. Drug costs count separately, under Part D's $2,400 cap.
These are the two main paths. Neither is right for everyone — it depends on your health, your doctors, your budget and how you like to get care.
| Medicare Advantage | Original Medicare + Medigap + Part D | |
|---|---|---|
| Doctors & hospitals | Usually the plan's network, mostly local | Any provider in the U.S. that accepts Medicare |
| Referrals & approvals | Often need referrals and prior approval for some care | Generally no referrals; fewer prior approvals |
| Monthly cost | Part B premium, plus plan premium (often $0) | Part B premium, plus Medigap and Part D premiums |
| Cost when you get care | Copays and coinsurance, up to the yearly limit | Low or no costs, depending on the Medigap plan |
| Drug coverage | Usually included | Separate Part D plan |
| Dental, vision, hearing | Often some coverage included | Generally not included |
| Changing later | Can switch plans every year | Changing Medigap plans later may require health questions |
Think ahead before you choose. In most states, if you choose Medicare Advantage now and want a Medigap policy later, the insurance company can ask health questions and may charge more or turn you down. Some states, such as New York, have different rules. Your Medigap Open Enrollment Period is the best time to buy Medigap without health questions.
Step 4 When to Enroll
Your Enrollment Windows
You can first join Medicare Advantage during your 7-month Initial Enrollment Period around your 65th birthday. After that, there are set times each year.
October 15 – December 7. Join, switch or drop a Medicare Advantage plan, or go back to Original Medicare. Changes start January 1.
Happening nowJanuary 1 – March 31. If you're already in a Medicare Advantage plan, you can switch to another one, or return to Original Medicare and join a drug plan — one time.
MA members onlyMoving out of your plan's area, losing other coverage, qualifying for Extra Help or Medicaid, or moving into a nursing home can let you change plans at other times.
Life eventsIf a plan in your area has Medicare's top 5-star rating, you can switch into it once at almost any time during the year.
Once a yearYour "trial right": if you join Medicare Advantage when you first get Medicare at 65 — or you drop a Medigap policy to try Medicare Advantage for the first time — you have 12 months to change your mind. You can go back to Original Medicare and buy a Medigap policy without health questions.
Step 5 Compare & Enroll
When You're Ready — And Only Then
A plan with a $0 premium isn't always the lowest cost for you. Before you choose, check each plan against your own doctors, drugs and health needs.
Check every plan for:
Choose your state to compare plans and enroll yourself:
Want to see every plan in your area? Use the Medicare Plan Finder at Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day. Free, unbiased counseling is also available from your State Health Insurance Assistance Program (SHIP).
You need both to join. Part A guide →
Part B guide →
How drug coverage works, inside or outside Medicare Advantage. Part D guide →
Your Annual Notice of Change shows what's changing for 2027. Read your ANOC →
No pressure · No sales calls · Your choice, your pace
Common Questions
Yes. You must keep Part A and Part B and continue paying your Part B premium, even if your Medicare Advantage plan has a $0 premium. Some plans pay part of your Part B premium for you — this varies by plan and area.
Neither is better for everyone. Medicare Advantage usually costs less each month and often includes drug coverage and extra benefits, but uses networks and copays. Original Medicare with Medigap usually costs more each month but lets you see any provider that accepts Medicare, with low costs when you get care.
Only if your doctor is in the plan's network — or, with a PPO, if you're willing to pay more to see them out of network. Always check before you enroll, and know that networks can change during the year.
For 2027, a Medicare Advantage plan can't make you pay more than $9,850 for covered in-network care, or $14,800 combined for in- and out-of-network care in a PPO. Many plans set lower limits. Prescription drug costs are counted separately under Part D.
Yes — during Open Enrollment (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31). But in most states, buying a Medigap policy later may require health questions, unless you're within your 12-month trial right.
Yes. Once you have Parts A and B, you can choose your state to compare the plans we offer and enroll yourself. You can also see every plan in your area at Medicare.gov.
Still have a question? Just ask.
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Education First. Enrollment Second.