Need an affordable
Medicare Advantage Part C?
$0 monthly premium Medicare plans may be available in your area.
Medicare Advantage Part C
What is a Medicare Advantage plan?
Medicare Advantage Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare.
Medicare Advantage is optional, but to obtain this private insurance, you must also have Original Medicare, Part A, and Part B. You also continue to pay your Part B premium if you have a Medicare Advantage plan. While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers.
Many Medicare Advantage plans include prescription drug coverage. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A, and Part B, does not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.
What’s NEW for 2025?
2025 Change | What it Means for Beneficiaries |
Record enrollment – ≈ 35.7 million people (≈ 54 % of all Medicare beneficiaries) | MA is now the majority choice, doubling the share seen a decade ago. |
Average MA premium → $17.00/mo (‑$1.23 vs 2024); 60 % of enrollees pay $0 | Competition among insurers continues to drive down premiums while benefits stay largely stable. |
New $2,000 annual out‑of‑pocket cap for Part D drugs | The Inflation Reduction Act phases in a hard ceiling on prescription costs, eliminating the “donut‑hole” effect. |
Stronger prior‑authorization & marketing rules | CMS Final Rule (CMS‑4205‑F) limits unnecessary prior‑auth, protects against high‑pressure sales tactics, and bans volume‑based broker commissions. |
Expanded mental‑health & telehealth access | Network‑adequacy standards now include clinical psychologists, licensed clinical social workers, and marriage & family therapists; many plans still waive cost‑sharing for virtual visits. |
Greater price‑transparency & digital access | Insurers must share standardized prior‑auth metrics and offer real‑time online decision tools to doctors and members. |
Is Medicare Advantage Right for You?
Use the quick‑check grid below to see whether an MA plan—or Original Medicare + Medigap—tends to fit your priorities. If three or more statements in a column sound like you, that option is probably worth a closer look.
You may prefer Medicare Advantage if… | You may prefer Original Medicare + Medigap if… |
You’re comfortable using a local network of providers. | You travel frequently or split time between multiple states. |
You like the idea of $0–$30 extra premiums on top of Part B. | You’re willing to pay higher premiums for near‑unlimited provider choice. |
You want dental, vision, hearing, gym, OTC, or meal benefits. | You already have stand‑alone coverage for those extras or don’t value them. |
You’re okay with prior‑authorization for some services. | You want minimal plan‑level rules once Medicare approves care. |
You’d rather have a built‑in annual spending cap than buy Medigap. | You prefer predictable, first‑dollar coverage for deductibles & coinsurance. |
Your doctors are in an MA network and accept the plan. | Your doctors don’t take MA plans or you don’t want to check networks. |
Rule of thumb: If you prioritize cost savings & convenience and your preferred providers are in‑network, MA is often the better value. If you prioritize provider freedom & nationwide portability, stick with Original Medicare + a Medigap Plan G or Plan N.
Types of Medicare Advantage (Part C) plans
It’s important to understand the differences between the types of Medicare Advantage plans to see which works best for you. There are several different types of Medicare Advantage plans:
- HMO (Health Maintenance Organization) – lowest cost sharing; referrals usually required.
- PPO (Preferred Provider Organization) – pay less in‑network but can use any doctor that accepts Medicare.
- PFFS (Private‑Fee‑for‑Service) – plan sets provider payment terms each visit.
- SNP (Special Needs Plan) – tailored for dual‑eligible, institutional, or chronic‑condition members; always includes drugs.
- HMO‑POS – HMO core with some out‑of‑network flexibility.
- MSA (Medical Savings Account) – high‑deductible plan + tax‑free bank deposit to spend on qualified expenses.
Costs & Savings in 2025
- Premiums: National average $17/mo; 4 in 5 beneficiaries have access to at least one $0‑premium plan.
- Deductibles & Copays: Vary by plan. Check your Summary of Benefits (SOB).
- Drug Costs: Once prescriptions total $2,000 out‑of‑pocket, you pay $0 for the rest of the year.
- Maximum OOP (medical): CMS limit $8,850 in‑network / $13,300 combined; many plans set lower caps.
Eligibility for Medicare Advantage plans
Who qualifies for a Medicare Advantage plan?
To enroll in any MA (or MAPD) plan you must:
Be enrolled in both Medicare Part A and Part B. (Part B premium still applies.)
Live in the plan’s service area at least six months per calendar year.
Be a U.S. citizen or lawfully present in the United States.
Not be incarcerated.
Have—or have applied for—a valid Social Security or Railroad Retirement Board number.
End‑Stage Renal Disease (ESRD) is no longer a barrier. Since Jan 1 2021, individuals with ESRD may join any Medicare Advantage plan available where they live.
Medicare Advantage plans cannot use medical underwriting—so they must accept all eligible applicants regardless of age or health history.
Key enrollment windows
| Period | When | What You Can Do |
| Initial Coverage Election Period (ICEP) | 3 months before → 3 months after your 65th birthday month (or 25th month of disability). | Enroll in an MA or MAPD plan for the first time. |
| Annual Election Period (AEP) | Oct 15 – Dec 7 every year. | Switch, add, or drop MA or Part D coverage for a Jan 1 effective date. |
| MA Open Enrollment Period (OEP) | Jan 1 – Mar 31. | If you already have MA, you may move to another MA plan or return to Original Medicare + Part D. |
| Special Election Period (SEP) | Year‑round after certain life events (move, loss of coverage, Extra Help, FEMA-declared emergency, etc.). | Make one change per qualifying event. |
Ready to Compare 2025 Plans?
Enter your ZIP code below or call our licensed agents 24/7 at 1‑877‑255‑0284 (TTY 711). We’ll search all carriers in your area and help you enroll online, by phone, or in‑person.
Find Medicare Plans in 3 Easy Steps
We can help get up to $0 monthly premium Medicare plans
Medicare Advantage v. Medigap (Medicare Supplement)
Medicare Advantage (MA / Part C): a bundled, privately administered alternative to Original Medicare that usually includes prescription‑drug coverage and extra benefits.
Medicare Supplement (Medigap): an add‑on policy that helps pay the deductibles, copays, and coinsurance left by Original Medicare; standardized plans A–N.
Side‑By‑Side Comparison – 2025
Feature | Medicare Advantage | Medigap + Original Medicare |
Monthly Premium (avg.) | $0–$30 above Part B (national avg. $17) | $100–$250 above Part B, varies by age, area & plan |
Provider Access | Local network (HMO, PPO, etc.); emergencies worldwide | Any U.S. doctor/hospital that takes Medicare; no networks |
Drug Coverage | Usually included (MAPD) | Requires separate Part D plan |
Extra Benefits | Dental • Vision • Hearing • Fitness • OTC • Meals (plan‑specific) | None (buy stand‑alone) |
Prior Authorization | Often required for non‑emergency services | Not applicable once Medicare approves care |
Annual Medical OOP Cap | Yes — CMS‑set ≤ $8,850 in‑network (2025) | No — but Medigap Plans G/N can shrink OOP to near‑zero |
Premium Stability | Can change Jan 1; easy to switch plans yearly | Can increase with age; switching later may require underwriting |
Travel Coverage | Routine care local; emergencies covered anywhere | Full U.S. portability; some Medigap plans add foreign‑travel emergencies |
Best For | Budget‑minded members who value extras & accept networks | People seeking maximum provider freedom & minimal red tape |
Choosing Between Them
Pick Medicare Advantage if you want one‑stop coverage, low or $0 extra premiums, and don’t mind staying in‑network.
Pick Medigap if you travel often, want any‑provider access, and prefer predictable costs without prior‑auth hurdles—even if premiums are higher.
You can’t have both at the same time. Joining one automatically cancels the other.
Switching Later
- MA → Medigap: After your 6‑month Medigap Open Enrollment Period (starts when Part B activates), insurers may medically underwrite and can deny coverage—except during limited guaranteed‑issue events (e.g., plan termination, trial‑right).
- Medigap → MA: You may enroll in an MA plan every year during AEP (Oct 15–Dec 7) or MA‑OEP (Jan 1–Mar 31); coverage starts the following month or Jan 1.
Compare Plans Side‑by‑Side
Ready to see premiums, star ratings, and extra benefits tailored to your ZIP code? Click the button below to launch our free plan‑comparison tool—no phone call needed.
Find Medicare Plans in 3 Easy Steps
We can help get up to $0 monthly premium Medicare plans
Compare plans today
Call a licensed insurance agent
+1 (877) 255-0284
