What Is Medicare Advantage?
Medicare Advantage (Part C) is a way to receive your Medicare benefits through a private insurance company that contracts with the federal government. These companies must cover everything that Original Medicare covers — but most go further, bundling in dental, vision, hearing, fitness benefits, and prescription drug coverage under a single plan.
More than half of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan, and that number grows every year. For many people — particularly those with stable local healthcare relationships — Medicare Advantage offers more comprehensive coverage at a lower total cost than Original Medicare plus supplemental coverage.
What Medicare Advantage Covers
- Everything covered by Original Medicare Parts A and B
- Prescription drug coverage (in most plans, built in as Part D)
- Routine dental, vision, and hearing in most plans
- Fitness memberships and wellness benefits in many plans
- Over-the-counter benefit allowances in some plans
- Transportation to medical appointments in qualifying plans
- A maximum annual out-of-pocket cap — which Original Medicare lacks entirely
How Medicare Advantage Is Different From Original Medicare
Provider Networks
Most MA plans require you to use a network of doctors and hospitals. HMO plans require referrals. PPO plans allow out-of-network care at higher cost. Before enrolling, confirm your doctors and preferred hospital are in-network.
Prior Authorization
Some services require prior authorization from the plan before you receive them. This is an additional administrative step compared to Original Medicare.
Out-of-Pocket Maximum
All Medicare Advantage plans must cap your annual out-of-pocket costs. In 2026, the maximum allowed cap is $9,350 for in-network services. This protection does not exist in Original Medicare.
Premiums
Many Medicare Advantage plans carry a $0 additional monthly premium — you still pay your Part B premium, but pay nothing extra for the MA plan itself. This makes MA attractive for cost-conscious beneficiaries.
The most important question before enrolling in any Medicare Advantage plan: Are your current doctors, specialists, and preferred hospital in this plan's network? A plan is only as good as the providers it includes. This is exactly the verification a local independent agent performs before making any recommendation.
HMO vs. PPO — The Two Main Types
HMO (Health Maintenance Organization) plans require you to choose a primary care physician and get referrals to see specialists. You must use in-network providers for all non-emergency care. HMOs typically have lower premiums and copays in exchange for these restrictions.
PPO (Preferred Provider Organization) plans give you the flexibility to see out-of-network providers, though at a higher cost. You do not need a referral to see a specialist. PPOs typically have slightly higher premiums but greater flexibility.
Special Needs Plans (SNPs)
Special Needs Plans are a type of Medicare Advantage plan designed for people with specific conditions or circumstances. Dual Special Needs Plans (D-SNPs) serve people who qualify for both Medicare and Medicaid (called Medi-Cal in California). Chronic Condition SNPs (C-SNPs) serve people with specific chronic illnesses. Institutional SNPs (I-SNPs) serve people living in institutions like nursing facilities. SNPs often provide highly coordinated, tailored care for the populations they serve.
How to Choose the Right Medicare Advantage Plan
Choosing the right plan requires comparing: your doctors' network participation, your prescription drug formulary, your expected healthcare utilization, the plan's star rating (quality measure), and total annual cost including premiums, deductibles, and copays. With 2,694 plan options represented through our network across 29 carriers, no two plans are identical — and the right plan for your neighbor may be entirely wrong for you. A local independent agent does this comparison work on your behalf at no cost to you.