What Is Medicare Advantage (Part C)?
Medicare Advantage, also called Medicare Part C, is a type of health insurance plan offered by private companies approved by Medicare. These plans provide all the coverage of Original Medicare (Part A and Part B) and typically include additional benefits that Original Medicare does not cover.
In 2026, more than 35 million Americans are enrolled in Medicare Advantage plans. Enrollment has grown steadily because MA plans offer an all-in-one alternative with predictable costs and extra benefits. You must have both Medicare Part A and Part B to enroll in a Medicare Advantage plan.
Every Medicare Advantage plan must cover the same services as Original Medicare. However, plans can charge different out-of-pocket costs and set their own rules for how you access services, such as requiring referrals or limiting coverage to in-network providers.
How Medicare Advantage Differs from Original Medicare
Original Medicare is a fee-for-service program run by the federal government. It covers hospital stays under Part A and doctor visits under Part B, but it does not cap your annual out-of-pocket spending. There is no built-in drug coverage, dental, vision, or hearing coverage.
Medicare Advantage plans are required to set a maximum out-of-pocket (MOOP) limit each year. In 2026, the CMS-mandated MOOP cap is $9,350 for in-network services. Once you reach that limit, your plan pays 100 percent of covered services for the rest of the year. This financial protection is a key reason many beneficiaries choose Medicare Advantage.
With Original Medicare, you can see any doctor who accepts Medicare assignment nationwide. Medicare Advantage plans use provider networks, which can limit your choices but often result in lower out-of-pocket costs for in-network care. Many MA plans also coordinate your care through a primary care physician.
Types of Medicare Advantage Plans: HMO vs. PPO
HMO (Health Maintenance Organization)
HMO plans require you to use doctors, hospitals, and other providers within the plan's network except in emergencies. You typically need a referral from your primary care physician to see a specialist. HMO plans often have lower premiums and copays because of their managed network approach.
PPO (Preferred Provider Organization)
PPO plans give you greater flexibility to see providers both in and out of network. You do not need referrals to see specialists. Out-of-network care is covered but at a higher cost. PPO plans tend to have slightly higher premiums in exchange for this broader provider access.
Other Plan Types
Less common MA plan types include PFFS (Private Fee-for-Service), which sets its own payment terms for providers, and SNP (Special Needs Plans), which serve beneficiaries with specific chronic conditions, institutional care needs, or dual eligibility for Medicare and Medicaid. HMO-POS plans offer limited out-of-network coverage at higher cost.
What Medicare Advantage Plans Cover
Prescription Drug Coverage (Part D)
Most Medicare Advantage plans include integrated Part D prescription drug coverage. These MA-PD plans cover your medications under the same plan that handles your medical benefits. This means one card, one premium, and one insurer managing all your coverage.
Dental, Vision, and Hearing
Many MA plans include routine dental exams, cleanings, fillings, and sometimes dentures. Vision benefits often cover annual eye exams, eyeglasses, or contact lenses. Hearing benefits may include annual hearing tests and hearing aid coverage or discounts. These benefits are not available under Original Medicare.
OTC Allowances and Supplemental Benefits
A growing number of Medicare Advantage plans offer quarterly or monthly over-the-counter (OTC) allowances. These credits — typically ranging from $50 to $200 per quarter — can be used at participating pharmacies and retailers to purchase health-related items such as pain relievers, vitamins, first aid supplies, and personal care products.
Fitness and Wellness Programs
Many Medicare Advantage plans include fitness benefits such as SilverSneakers or similar gym membership programs at no additional cost. Some plans also cover wellness services like nutrition counseling, telehealth visits, meal delivery after hospital stays, and transportation to medical appointments.
Star Ratings: Understanding Plan Quality
Medicare evaluates every Medicare Advantage plan using a Star Rating system scored from 1 to 5 stars. These ratings are published annually by the Centers for Medicare and Medicaid Services (CMS) and reflect each plan's quality of care, member experience, and administrative performance.
Star Ratings are based on dozens of quality measures grouped into categories: staying healthy (screenings, vaccines), managing chronic conditions (diabetes care, blood pressure control), member experience (satisfaction surveys, complaint rates), and customer service (call center performance, appeals processing).
Plans that earn 5 stars receive a special distinction: beneficiaries can enroll in them at any time during the year, not just during open enrollment. Higher-rated plans also receive quality bonus payments from CMS, which they often reinvest into richer benefits for members.
How to Choose the Right Medicare Advantage Plan
Start by listing your priorities: prescription drug costs, preferred doctors, specialist access, dental and vision needs, and monthly budget. Every beneficiary's situation is different, so the best plan for one person may not suit another.
Check the plan's provider directory to confirm your current doctors and hospitals are in network. Review the formulary to see if your medications are covered and at what tier. Compare total annual costs — not just the premium, but also deductibles, copays, coinsurance, and the maximum out-of-pocket limit.
Look at the plan's Star Rating for overall quality and pay attention to measures that matter most to you, such as chronic disease management if you have ongoing health conditions. A licensed Medicare agent can help you compare plans side by side at no cost and with no obligation.