Medicare Advantage — Part C — is an alternative way to receive your Medicare benefits. Instead of Original Medicare paying your hospital and doctor bills directly, a private insurance company that contracts with Medicare provides your Part A and Part B coverage. Most plans bundle Part D prescription drug coverage as well, and many add benefits Original Medicare doesn't include.
Are you eligible?
You can join a Medicare Advantage plan if you have both Medicare Part A and Part B and live in the plan's service area. People with End-Stage Renal Disease (ESRD) can join too. You can only be in one Medicare Advantage plan at a time.
What every plan must cover
All Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, including emergency and urgent care. The exception is hospice: if you elect hospice, Original Medicare pays for hospice-related care while you stay in your plan. Plans can't charge more than Original Medicare for certain services, such as chemotherapy, dialysis and skilled nursing facility care.
What you'll pay
- Your Part B premium ($202.90/month standard in 2026), unless Medicaid or a Medicare Savings Program pays it.
- The plan's monthly premium, if any. Many plans have a $0 premium.
- Deductibles, for medical care, drugs, or both — some plans have none.
- Copayments or coinsurance each time you get a covered service.
- Out-of-network costs, if your plan allows out-of-network care.
Comparing the plan types
| HMO | PPO | PFFS | SNP | |
|---|---|---|---|---|
| Primary care doctor required? | Usually | No | No | Usually |
| Referral for specialists? | Usually | No | No | Usually |
| Out-of-network coverage? | Emergencies only (POS plans vary) | Yes, higher cost | If provider accepts terms | Varies |
| Drug coverage? | Usually | Usually | Sometimes | Always |
Prior authorization, explained
Medicare Advantage plans can require prior authorization — approval before you get certain services or drugs — so the plan can confirm they're medically necessary and covered. Your doctor usually handles the request. If a request is denied, you have the right to appeal. Ask your agent which services in a plan require prior authorization.
Star ratings
Medicare rates Medicare Advantage and Part D plans from 1 to 5 stars based on quality and performance — things like preventive screenings, managing chronic conditions, member experience and customer service. Ratings are updated every year and published on Medicare.gov. A 5-star plan creates a Special Enrollment Period: you can switch into one once between December 8 and November 30.
Your rights in a Medicare Advantage plan
- Receive emergency care anywhere in the U.S.
- Get a decision about coverage and appeal a denial.
- Get information in a format you can use, and file a complaint (grievance).
- Have your personal health information kept private.
Switching or leaving
You can change Medicare Advantage plans or return to Original Medicare during Open Enrollment (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31), and at other times if you qualify for a Special Enrollment Period. See all enrollment windows.
Questions people ask us
Can I travel with Medicare Advantage?
Emergency and urgent care are covered anywhere in the U.S. Routine care away from home depends on the plan — some PPOs and plans with visitor/travel programs offer more flexibility.
What if I move?
Moving out of your plan's service area gives you a Special Enrollment Period to choose a new plan.
Is there a health questionnaire?
No. Medicare Advantage plans can't deny you based on pre-existing conditions (Special Needs Plans have eligibility requirements tied to the special need).