What Is Medicare Advantage (Medicare Part C)?

Medicare Advantage, also called Medicare Part C, is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans provide all Medicare Part A (hospital insurance) and Part B (medical insurance) benefits and often include additional coverage such as prescription drugs, dental, vision, hearing, and wellness programs.

What is Medicare Advantage?

Medicare Advantage is an alternative way to receive your Medicare benefits.

Instead of receiving Part A and Part B coverage directly from the federal government through Original Medicare, you enroll in a Medicare Advantage plan offered by a private insurance company that has been approved by Medicare.

Every Medicare Advantage plan must provide at least the same level of coverage as Original Medicare for Medicare-covered services, although plans may have different provider networks, cost-sharing requirements, and additional benefits.

How does Medicare Advantage work?

After enrolling in Medicare Part A and Part B, eligible beneficiaries may choose a Medicare Advantage plan if one is available where they live.

When you enroll:

• Medicare pays the private insurance company to administer your Medicare benefits.
• You continue to receive all covered Part A and Part B services through your Medicare Advantage plan.
• Many plans also include Medicare Part D prescription drug coverage.
• Some plans offer benefits not included in Original Medicare, such as routine dental, vision, hearing, fitness programs, or transportation services.

You remain enrolled in Medicare even though a private company administers your coverage.

Who is eligible for Medicare Advantage?

Generally, you must:

• Be enrolled in Medicare Part A.
• Be enrolled in Medicare Part B.
• Live in the plan's service area.
• Meet any additional eligibility requirements established by Medicare.

People with End-Stage Renal Disease (ESRD) are now generally eligible to enroll in Medicare Advantage plans, although certain plan availability and network considerations may apply.

What does Medicare Advantage cover?

Every Medicare Advantage plan must cover all medically necessary services covered under Original Medicare.

Depending on the plan, additional benefits may include:

• Prescription drug coverage (Part D)
• Routine dental care
• Vision exams and eyewear
• Hearing exams and hearing aids
• Fitness memberships
• Telehealth services
• Transportation to medical appointments
• Over-the-counter health benefit allowances

Benefits vary by plan and geographic area.

Medicare Advantage vs. Original Medicare

These two options provide Medicare benefits differently.

Medicare Advantage

• Administered by private insurance companies approved by Medicare.
• Often includes additional benefits beyond Original Medicare.
• Usually uses provider networks such as HMOs or PPOs.
• Annual out-of-pocket maximums apply for covered Part A and Part B services.
• May include prescription drug coverage.

Original Medicare

• Administered directly by the federal government.
• Includes Medicare Part A and Part B.
• Generally allows beneficiaries to see any provider nationwide who accepts Medicare.
• Does not include an annual out-of-pocket maximum for Part A and Part B services.
• Prescription drug coverage requires separate enrollment in a Medicare Part D plan.

Medicare Advantage vs. Medigap

These programs are commonly confused but cannot generally be used together.

Medicare Advantage

• Replaces Original Medicare as the way you receive your Medicare benefits.
• Often includes additional benefits.
• Uses plan-specific provider networks.

Medigap

• Supplements Original Medicare.
• Helps pay certain out-of-pocket costs such as deductibles, copayments, and coinsurance.
• Does not work with Medicare Advantage plans.

If you enroll in a Medicare Advantage plan, you generally cannot use a Medigap policy to pay that plan's costs.

What costs should you expect?

Costs vary by plan and may include:

• Your Medicare Part B premium.
• An additional monthly plan premium (for some plans).
• Deductibles.
• Copayments.
• Coinsurance.

Unlike Original Medicare, every Medicare Advantage plan has an annual maximum out-of-pocket limit for covered Part A and Part B services, offering an important financial protection against very high medical expenses.

Why this matters

Choosing between Original Medicare and Medicare Advantage is one of the most important healthcare decisions many older adults make. While Medicare Advantage plans often provide additional benefits and annual limits on out-of-pocket spending, they may also use provider networks and require referrals or prior authorization depending on the plan.

Understanding these differences helps beneficiaries choose coverage that fits their healthcare needs, preferred providers, travel patterns, and budget.