Medicare Advantage

What Medicare Advantage covers

Medicare Advantage plans must cover everything Original Medicare covers. Beyond that, most plans add prescription drug coverage (Part D) and extras like dental cleanings, vision exams, and hearing aids. Plans are offered by private insurance companies that contract with Medicare, so benefits, costs, and networks vary by plan and ZIP code. Unlike Original Medicare, every Medicare Advantage plan also includes an annual out-of-pocket maximum that caps what you pay for covered medical care each year.

• Hospital stays (Part A): Inpatient care, skilled nursing, hospice.
• Doctor visits (Part B): Outpatient care, preventive services, durable medical equipment.
• Prescription drugs (Part D): Included in most plans, with no separate drug plan needed.
• Dental, vision, hearing: Routine cleanings, eye exams, and hearing aids in most plans.
• Extra benefits: OTC allowances, transportation, fitness memberships on select plans.

Who it is for

Medicare Advantage tends to fit people who want predictable, lower out-of-pocket costs, are comfortable using a network of providers, and want benefits like dental and vision bundled in. If you travel frequently or want nationwide coverage with any doctor, a Medicare Supplement plan may be a better fit. Your licensed insurance agent will compare both side by side.

How Medicare Advantage plans work

Medicare Advantage is one of several Medicare coverage options, and it is worth knowing how it sits against the parts of Medicare before comparing any individual plan. When you join a plan, the plan pays for your covered care. You still have Medicare and you keep all your Medicare rights. You show the plan's card rather than your red, white and blue Medicare card when you get care. Most plans also fold in prescription drug coverage, which is what makes a plan an MAPD. Each plan sets its own costs and rules within federal limits, which is why two plans in the same county can look very different.

• Provider networks: Most plans contract with a specific set of doctors and hospitals.
• Referrals: Some plan types require one before you see a specialist.
• Prior authorization: Certain services need the plan's approval in advance.
• Copays instead of coinsurance: A set dollar amount per visit, rather than the 20% Original Medicare leaves you for most outpatient care.
• Emergency care travels: Plans must cover emergency and urgently needed care anywhere in the U.S., including out of network.

The types of Medicare Advantage plan

Plan type decides how much freedom you have to choose providers, and it is usually the first thing to settle. If you are weighing the two most common, Medicare HMO vs. PPO plans is the comparison to read. Special needs plans are narrower: one kind serves people who have both Medicare and Medicaid, which usually means they also qualify through Medicare Savings Programs, and that plan is called a dual eligible SNP. Here is an example of a dual eligible PPO plan if you want to see how one is laid out. Some HMOs also offer a point-of-service option that allows out-of-network care for certain services, so check the plan's Evidence of Coverage rather than assuming from the plan type alone.

• HMO: You generally use in-network doctors and need a referral for specialists. Lower costs in exchange for a tighter network.
• PPO: You can go out of network at a higher cost, and referrals usually are not required.
• SNP: Built for people with certain chronic conditions, people in nursing homes, or people who have both Medicare and Medicaid. The last of those is a dual eligible SNP.
• PFFS and MSA: Private fee-for-service and medical savings account plans. Both are much less common.

What a Medicare Advantage plan costs

Three things make up the cost, and the third is the one people miss. You keep paying your Part B premium even if the plan itself charges $0 a month, and the standard 2027 Part B amount has not been announced by CMS yet; our page on Medicare costs and premiums covers how that premium is set. On top of that a plan may charge its own premium, a deductible for medical care or drugs, and then copays or coinsurance. The part worth understanding is the cap: Original Medicare has no yearly limit on what you can be charged, while every Medicare Advantage plan must have one for in-network hospital and medical services, and once you reach it the plan pays the full cost of covered services for the rest of the year. CMS sets the federal maximum for that limit each year and has not published the 2027 figure yet.

What you pay for prescription drugs in 2027

Drug coverage follows federal limits whether you get it inside a Medicare Advantage plan or through one of the stand-alone Part D plans. For 2027, no plan's drug deductible can exceed $700, once your out-of-pocket drug costs reach $2,400 you pay nothing for covered drugs for the rest of the year, and a one-month supply of each covered insulin product costs no more than $35. Extra Help can lower all of those further if you qualify.

The extra benefits, and their limits

Many plans add extra benefits Original Medicare does not cover at all: routine dental and vision care, hearing exams and hearing aids, gym or fitness memberships, an allowance for over-the-counter health products, and rides to medical appointments. They are a real part of the value, but they vary by plan and by ZIP code more than any other feature, and an allowance is not the same as full coverage. Read the plan's Summary of Benefits for the actual dollar amounts rather than the headline.

Compared with Original Medicare and Medigap

With Original Medicare you can see any doctor in the country who accepts Medicare, and many people pair it with Medicare Supplement (Medigap) plans to cover the coinsurance, plus a separate drug plan. With Medicare Advantage you get everything in one plan, usually with extras and always with a yearly out-of-pocket cap, in exchange for using a network and getting approval for some care. You cannot use a Medigap policy to pay Medicare Advantage costs, so this is a real fork rather than something to layer. Neither is right for everyone: our side-by-side on Medicare Advantage vs. Medicare Supplement goes through it, and if cost is the deciding factor there are programs for help paying Medicare costs that apply either way.

When you can enroll

You can join a Medicare Advantage plan if you have Part A and Part B and you live in the plan's service area, so it is worth checking who is eligible first. There are four Medicare enrollment periods, and which one applies to you changes what you are allowed to do. The first is the seven-month window around your 65th birthday, covered in our guide to turning 65. A Special Enrollment Period can also open after certain life events.

• Initial Enrollment Period: The 7-month window around the month you turn 65.
• Annual Enrollment Period: October 15 to December 7 each year, with changes starting January 1.
• Medicare Advantage Open Enrollment: January 1 to March 31, when someone already in a plan can switch once or return to Original Medicare.
• Special Enrollment Period: Opens after certain life events, such as moving or losing other coverage.

How to compare plans without guessing

The comparison that matters is not premium against premium. A $0 premium plan can cost more over a year than one with a premium, depending on the care you actually use. Our open enrollment checklist walks through it in order: list your doctors and check each plan's network, list your prescriptions and check each plan's drug list, then compare the yearly out-of-pocket limit and the copays for the care you use most. Star ratings and the extras break the remaining ties. When you have picked one, here is how to enroll in Medicare, and a licensed insurance agent can run the whole comparison with you at no cost.

Common questions