What is Medicare Advantage?
Medicare Advantage (Part C) plans are private health insurance plans that contract with Medicare to provide your Part A and Part B benefits. Instead of the government paying your doctors and hospitals directly (as in Original Medicare), a private insurer manages your care.
You must still be enrolled in Medicare Parts A and B and pay your Part B premium ($185/month in 2026). The Advantage plan then charges its own premium on top — often $0, but sometimes more — and you use the plan's network of doctors and hospitals.
The key differences
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Provider choice | Any provider that accepts Medicare nationwide | Network only (HMO) or higher costs out-of-network (PPO) |
| Out-of-pocket max | None — unlimited exposure | Capped (max $9,350 in-network in 2026) |
| Drug coverage | Need separate Part D plan | Usually included (MAPD) |
| Extra benefits | None | Often includes dental, vision, hearing, gym |
| Prior authorization | Minimal | Often required for procedures |
| Travel coverage | Nationwide | Emergency only outside network |
| Referrals needed? | No | Often yes (HMO plans) |
Who Medicare Advantage is right for
- People who want predictable costs with an out-of-pocket maximum
- People who want extra benefits like dental, vision, and hearing
- People who are generally healthy and don't need frequent specialist care
- People who live in one area and don't travel much
- People who want a lower (or $0) monthly premium
Who Original Medicare + Medigap is right for
- People with serious or chronic conditions who need frequent specialist access
- People who travel frequently or snowbirds who spend time in multiple states
- People who want to see any doctor in the country without referrals
- People who value predictability and dislike dealing with insurance network issues
- People who can afford the higher Medigap premium for comprehensive coverage
⚠️ The Medigap timing trap: If you enroll in Medicare Advantage first and later want to switch to Original Medicare + Medigap, you may not be able to get a Medigap plan at standard rates — insurers can charge more or deny coverage based on your health (except in states like CT, MA, NY, ME). Choose carefully when you first enroll.
How to evaluate Medicare Advantage plans
Medicare rates all plans on a 5-star scale. Plans rated 4–5 stars consistently perform better on quality metrics. Check ratings at Medicare.gov's Plan Finder. Key things to evaluate:
- Is your doctor in the network? This is the most important factor.
- Are your drugs covered? Check the formulary for all your current medications.
- What is the plan's star rating? Choose 4+ stars when available.
- What is the out-of-pocket maximum? Lower is better for catastrophic protection.
- What extra benefits are included? Dental, vision, and gym memberships add real value.