What does Medicare Advantage cover?
You must have both Part A and Part B and continue paying your Part B premium. Plans cover medically necessary Part A and Part B services. Original Medicare generally pays for hospice care, certain clinical research and some new benefits during specified periods.
Most plans include Part D prescription drug coverage. Some offer dental, vision, hearing, fitness or other benefits that Original Medicare does not cover. Benefits are not available in every plan or location; limits, provider networks and eligibility rules apply.
What could you pay in 2026 and 2027?
Compare total costs, not only the premium. A plan advertised with a $0 monthly premium can still have deductibles, copayments and coinsurance. Your Part B premium usually continues. Plans have a yearly out-of-pocket limit for covered Part A/B care, but drug costs and premiums are separate.
| Cost to review | What to check |
|---|---|
| Monthly premium | Your Part B premium plus any additional plan premium. |
| Medical care | Primary care, specialists, hospital stays, tests and out-of-network cost sharing. Read the plan’s Summary of Benefits. |
| Annual medical limit | The plan’s in-network limit and, where applicable, combined limit. Do not assume one nationwide amount applies to every plan. |
| Part D drug limit | For covered Part D drugs: $2,100 in 2026; $2,400 in 2027. Premiums and non-covered drugs do not count toward this limit. |
| Plan year | Use 2026 documents for 2026 care and 2027 documents for coverage beginning in 2027. Benefits and networks can change. |
There is no single plan that fits everyone. An agent can help review the carriers and plans we represent in your county; Medicare.gov lists additional options.
Types of Medicare Advantage plans
| Type | How it works |
|---|---|
| HMO | Generally uses a network, except for emergency care, urgent care and out-of-area dialysis. Referrals may be required. |
| HMO-POS | An HMO that permits some out-of-network services at a higher cost. |
| PPO | Typically costs less in network. Covered out-of-network care may cost more; the provider must agree to treat you and plan rules apply. |
| PFFS | The plan sets payment terms. Confirm that each provider agrees to the plan’s terms; some plans have networks. |
| SNP | A Special Needs Plan serves eligible people with certain conditions, institutional needs or Medicare and Medicaid. SNPs include drug coverage. |
| MSA | A high-deductible plan paired with a medical savings account. It does not include Part D; separate drug coverage may be needed. |
Is Medicare Advantage right for you?
- Check whether your regular doctors, hospitals and specialists participate in the specific plan.
- List your prescriptions, dosages and preferred pharmacies. Compare total yearly drug costs.
- Consider how often you travel and whether you need routine care away from home.
- Ask which services need prior authorization or referrals.
- Check dental or eyewear limits instead of assuming an advertised allowance covers every service.
If broad nationwide access with Original Medicare is your priority, also explore Medigap. A plan comparison should reflect your needs, not a score or a one-size-fits-all rule.
Who can enroll?
Generally, you need Medicare Part A and Part B, must live in the plan’s service area and be a U.S. citizen or lawfully present in the United States. You must have an eligible enrollment period. Special Needs Plans have additional requirements. People with End-Stage Renal Disease can enroll when eligible.
A move, extended time outside a plan’s service area, incarceration or a change in other coverage can affect eligibility. Ask the plan or Medicare to confirm your circumstances before applying.
When can you enroll or change plans?
| Period | When | What it means |
|---|---|---|
| Initial enrollment | Generally the seven-month period around your 65th birthday. Disability and other circumstances can change the timing. | Enroll in Medicare when first eligible; confirm your health and drug plan election dates. |
| Annual Open Enrollment | October 15–December 7, 2026 | Make eligible health and drug plan changes for January 1, 2027. |
| Medicare Advantage Open Enrollment | January 1–March 31 | People already in Medicare Advantage can make one eligible change to another MA plan or return to Original Medicare, with an opportunity to join a Part D plan. |
| Special Enrollment Period | Depends on the qualifying event | Moving, loss of certain coverage or other qualifying circumstances may allow a change. The deadline and allowed change depend on the event. |
See our enrollment guide before changing current coverage. Do not cancel coverage until the new effective date and any other coverage changes are confirmed.
Medicare Advantage compared with Medigap
| Feature | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
| How coverage works | A private plan provides your Part A and Part B benefits. | Original Medicare pays first; a Medigap policy helps with specified remaining costs. |
| Doctors and hospitals | Network, referral and prior-authorization rules depend on the plan. Check each doctor and facility. | Usually any provider in the U.S. that accepts Medicare. Medicare SELECT policies can have network requirements. |
| Prescription drugs | Most plans include Part D; verify each medication and pharmacy. | New Medigap policies do not include Part D. A separate drug plan may be needed. |
| Monthly premiums | Part B still applies; the plan may charge another premium. A $0 plan premium does not mean $0 total cost. | Part B, Medigap and any separate Part D premiums apply. |
| Medical out-of-pocket costs | A yearly limit applies to covered Part A/B services; network and other rules affect the limit. | Original Medicare alone has no annual limit. Medigap pays the benefits specified by its plan letter. |
| Dental, vision and hearing | Some plans include extra benefits with limits, networks and eligibility conditions. | Medigap generally does not cover routine dental, vision or hearing services. |
| Travel and moving | Emergency and urgent care rules differ from routine care. Foreign emergency benefits are plan-specific. | Medicare works nationwide with participating providers; certain Medigap plans include limited foreign travel emergency benefits. |
| Changing coverage later | You need an applicable enrollment period. | Outside protected enrollment rights, medical underwriting may apply. State rules differ. |
Medigap does not pay Medicare Advantage cost sharing. Joining Medicare Advantage does not automatically cancel a Medigap policy. Arrange any cancellation carefully. A later return to Medigap is not always guaranteed; protected rights and state law matter.
Compare plans with your own priorities
Have your ZIP code, Medicare effective dates, doctors, prescriptions and preferred pharmacy ready. Review the Summary of Benefits and Evidence of Coverage, including star ratings, covered services and exclusions. Keep a copy of the enrollment confirmation and verify your start date.
Compare the insurance carriers we work with or speak with a Licensed Insurance Agent.