Medicare Advantage is an alternative way to get your Medicare benefits through a private insurance company instead of the government program

Instead of using Original Medicare (Part A and Part B), you can choose a Medicare Advantage plan — sometimes called Part C — run by a private insurer like UnitedHealth, Humana, or Anthem. The government still pays the insurance company a fixed amount each month to cover you. In return, the plan must cover everything Original Medicare covers, plus usually dental, vision, or hearing benefits that Original Medicare does not. The trade-off is that you have a network: you must use doctors and hospitals in that network, or pay more out of pocket.

Medicare Advantage plans are popular because they often have lower monthly premiums than Original Medicare plus a Medigap policy, and they include prescription drug coverage built in. But the costs you pay when you actually use care — copays, coinsurance, deductibles — can add up quickly, and you need to check your plan's network before you choose.

Key Takeaways

  • Medicare Advantage is run by private insurance companies and requires you to use doctors and hospitals in their network, except in emergencies.
  • Your monthly premium is often lower than Original Medicare, but you pay copays and coinsurance when you see a doctor or get care.
  • Most Medicare Advantage plans include prescription drug coverage and dental or vision benefits that Original Medicare does not cover.
  • You can switch plans or return to Original Medicare during the Annual Enrollment Period each October through December, or if you move out of your plan's service area.
  • Out-of-pocket costs have an annual cap, so your total spending cannot exceed a set limit each year.

How the Network Works and Why It Matters

Every Medicare Advantage plan has a network of doctors, hospitals, and other providers. When you see someone in the network, you pay the copay or coinsurance your plan sets. If you see someone outside the network, you pay much more — sometimes the full cost — unless it is an emergency.

Before you choose a plan, check whether your current doctors are in the network. Use the plan's provider search tool on their website, or call the plan's customer service number. Ask specifically whether your primary care doctor, any specialists you see regularly, and your preferred hospital are in-network. If your doctor is not in the network and you want to keep seeing them, you may need to pick a different plan or switch back to Original Medicare.

Emergency care is covered even outside the network, so you do not have to worry about that. But routine care, specialist visits, and planned procedures must be in-network to get the lower cost-sharing.

What You Pay: Premiums, Copays, and Annual Limits

A Medicare Advantage plan has four types of costs. The monthly premium is what you pay to the insurance company — often $0, but sometimes $50 to $200 or more, depending on the plan. You still pay your Part B premium to Medicare separately. Some plans also charge a deductible before coverage kicks in, usually $0 to $500 per year.

When you use care, you pay a copay (a flat amount, like $25 to see your doctor) or coinsurance (a percentage of the cost, like 20 percent). These add up throughout the year. The good news is that Medicare Advantage has an out-of-pocket maximum — a yearly cap on what you pay. Once you hit that limit, the plan covers everything else for the rest of the year. The maximum varies by plan but is set by Medicare each year.

Prescription drugs are included in your plan's costs and count toward your out-of-pocket maximum. You do not need a separate Part D plan.

Extra Benefits You Usually Get

Most Medicare Advantage plans include benefits Original Medicare does not: dental (cleanings, fillings, sometimes dentures), vision (eye exams, glasses or contacts), and hearing (exams and hearing aids). Some plans also cover fitness programs, transportation to medical appointments, or over-the-counter health items like pain relievers or bandages.

These extras vary widely by plan and by region. A plan in one county might offer free dental, while the same company's plan in the next county offers only a discount. Check what each plan you are considering actually covers — do not assume all plans from the same company are the same.

Prescription Drug Coverage Built In

Medicare Advantage includes prescription drug coverage as part of the plan. You do not buy a separate Part D plan. Your copay for drugs depends on the plan and the drug: generic drugs might cost $5, brand-name drugs $35 to $75, and specialty drugs more. The plan's formulary — its list of covered drugs — determines which medications are covered and at what cost.

Before you choose a plan, check whether your regular medications are on the formulary and what you will pay for them. If your doctor prescribes a drug that is not covered, you can ask the plan for an exception, but that takes time. If cost is a barrier, talk to your doctor about whether a covered alternative exists.

When You Can Switch Plans or Go Back to Original Medicare

You can change your Medicare Advantage plan or switch to Original Medicare during the Annual Enrollment Period, which runs from October 15 through December 7 each year. Changes take effect January 1. You can also switch if you move out of your plan's service area — for example, if you move to another state or to a county your plan does not serve. In that case, you have a special window to change plans without waiting for the annual period.

If you switch back to Original Medicare, you can also sign up for a Medigap policy (supplemental insurance) to cover costs that Original Medicare does not. However, Medigap premiums can be higher if you wait to sign up, so timing matters. You have 63 days from when you leave your Medicare Advantage plan to sign up for Medigap without a waiting period in most states.

How to Choose a Medicare Advantage Plan

Start by listing the doctors and hospitals you use. Then visit Medicare.gov and use the Plan Finder tool. Enter your zip code and the medications you take. The tool will show you all plans available in your area, their premiums, copays, and whether your doctors are in-network.

Compare at least three plans. Look at the total cost you expect to pay in a year — not just the premium, but also copays for the care you actually use. If you see a specialist four times a year, a plan with a $50 specialist copay costs more than one with a $25 copay. If you take three medications, check the copay for each one. Add it up.

Call the plans' customer service lines with questions. Ask whether your doctors are in-network, whether your drugs are covered, and what the out-of-pocket maximum is. Write down the answers. The best plan on paper is not the best plan if your doctor is not in it.

Frequently Asked Questions

Can I use my Medicare Advantage plan if I travel or move?

Most Medicare Advantage plans are regional — they cover care only in a specific service area. If you travel outside that area, you can use emergency care anywhere, but routine care is not covered. If you move permanently out of your plan's service area, you can switch to a different plan or return to Original Medicare without waiting for the annual enrollment period.

What happens if my doctor leaves the network?

If your in-network doctor leaves the plan, the insurance company should notify you. You can then see that doctor out-of-network and pay the out-of-network cost, or switch to a different in-network doctor. If losing your doctor is a major problem, you can switch plans or return to Original Medicare during the next enrollment period, or when ready if you move.

Do I still have to pay my Part B premium with Medicare Advantage?

Yes. Your Part B premium goes to Medicare, and your plan premium (if any) goes to the insurance company. You pay both. Part B covers doctor visits and outpatient care; the Medicare Advantage plan is the way you receive those benefits instead of using Original Medicare directly.

What if I need care outside my plan's network?

Emergency care is covered anywhere. For non-emergency care, you pay the out-of-network cost, which is usually much higher than the in-network copay. Some plans offer limited out-of-network coverage for urgent care, but you should assume routine care outside the network is your responsibility. Check your plan's documents for specifics.

Can I have both Medicare Advantage and Medigap?

No. If you have a Medicare Advantage plan, you cannot use Medigap. Medigap is designed to work with Original Medicare. If you switch from Medicare Advantage to Original Medicare, you can then buy Medigap, but you have a limited time window to do so without higher premiums.