Medicare Advantage, also called Part C, is a way to receive Medicare benefits through a private plan approved by Medicare. You must have both Part A and Part B, live in the plan’s service area and enroll during an allowed period. Availability and costs depend on the exact plan and coverage year.
What a plan covers
Medicare Advantage covers the medically necessary Part A and Part B services required by Medicare. Original Medicare remains responsible for hospice and certain other exceptions, including some clinical-research costs. Most plans include Part D, and plans may offer extra benefits such as dental, vision or hearing coverage.
Extra benefits differ. Check eligibility conditions, participating providers, frequency limits and any annual allowance before relying on a benefit. A carrier’s advertisement does not establish your particular coverage.
Common plan types
| Type | Key question |
|---|---|
| HMO | Are your routine-care providers in the network? Emergency care, urgent care and out-of-area dialysis have exceptions. Referrals are usually required. |
| PPO | What will covered out-of-network care cost, and will the provider agree to see you? Specialist referrals are generally not required. |
| Special Needs Plan | Do you meet its additional Medicaid, chronic-condition or institutional eligibility rules? |
| Other arrangements | Private Fee-for-Service and Medical Savings Account plans have different provider and payment rules; read their documents separately. |
A referral and prior authorization are different. A plan that does not require a specialist referral may still require advance approval for a particular service.
Costs beyond the advertised premium
You generally continue paying your Part B premium and any applicable Part A premium. The plan may charge an additional premium. Compare deductibles, copayments, coinsurance and the annual limit for covered medical services. A $0 plan premium does not mean all care is free.
The medical out-of-pocket limit and Part D spending rules are different. Review each separately, including any distinction between in-network and out-of-network medical limits.
Before enrolling or changing
- Confirm the plan name, identification number, service area and year.
- Verify each doctor, hospital and other essential provider with both the plan and the office.
- Review medical costs and any Part D coverage securely with the plan.
- Check referral and authorization rules for care you expect to need.
- Ask an employer or union benefits administrator before changing coverage that covers you or family members.
- Confirm your enrollment period and effective date before canceling existing coverage.
Medigap is different from Medicare Advantage and does not pay its copayments. Moving back to Original Medicare does not automatically guarantee a right to buy Medigap without underwriting. Review that question separately before switching.
Related coverage questions
- How to Enroll in Medicare: Steps, Timing and Where to Get Help
- Who Is Eligible for Medicare? Age, Disability and Enrollment
- How to Verify Your Medicare Coverage and Plan Enrollment