Medicare Advantage (Part C)

How Medicare Advantage works

Medicare Advantage (also called Part C) is an all-in-one way to get your Medicare benefits through a private insurance plan instead of directly from the federal program. When you join an Advantage plan, you still have Medicare — but the plan, not Original Medicare, manages your Part A (hospital) and Part B (medical) coverage, and almost always folds in Part D prescription drug coverage too.

Because everything is bundled, most plans add benefits Original Medicare doesn't include — routine dental, vision, and hearing, a fitness membership, and sometimes an over-the-counter allowance. In exchange, you agree to use the plan's rules: a provider network, referrals on some plans, and prior authorization for certain services.

What it covers — and the tradeoffs

By law, every Advantage plan has to cover everything Original Medicare covers. The differences are in how you get that care:

• Networks. HMO plans generally cover only in-network providers (except emergencies); PPO plans let you go out of network for a higher share of the cost.
• Referrals and prior authorization. Some plans require a referral to see a specialist, and many require approval before certain tests, procedures, or hospital stays.
• Extra benefits. Dental, vision, hearing, and fitness perks vary widely from plan to plan and year to year, so they're worth comparing closely.

What you still pay in 2026

Joining an Advantage plan doesn't replace your Part B premium. You keep paying it — $202.90 a month at the standard 2026 rate, more if a higher income triggers IRMAA — and then pay the plan's premium on top, which is frequently $0. From there you pay copays and coinsurance as you use care until you hit the plan's out-of-pocket maximum.

So a "$0 premium" plan is rarely $0 overall. The real comparison is the whole picture: the monthly premium, the copays for the doctors and drugs you actually use, the network your providers are in, and that yearly out-of-pocket ceiling.

Is Medicare Advantage right for you?

Advantage tends to fit people who want predictable, lower upfront costs and don't mind staying in a network, and who like having drug coverage and extras bundled into one plan and one card. It can be a tougher fit if you travel often, split the year between states, want any specialist without a referral, or expect frequent care from specific out-of-network providers.

There's no single right answer — it depends on your doctors, your prescriptions, your budget, and how you like to get care. The honest way to choose is to compare the specific plans available where you live against a Medicare Supplement, which works in the opposite way.