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Medicare Part C Explained

What Is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a Medicare-approved private health plan that provides your Part A and Part B benefits instead of Original Medicare. Most plans also include Part D drug coverage and may offer extra benefits such as dental, vision, and hearing.

Updated August 2026 Medicare Advantage = Medicare Part C
Compare Medicare Advantage Plans See How Medicare Advantage Works
What is Medicare Advantage Part C explained
Medicare Part A + B Included The plan provides your Medicare-covered hospital and medical benefits.
Prescription Drugs Usually Included Most Medicare Advantage plans include Medicare Part D drug coverage.
Annual Protection Out-of-Pocket Limit Plans place an annual limit on what you pay for covered Part A and Part B services.
Quick Answer

Medicare Advantage is the same thing as Medicare Part C

A Medicare Advantage plan is another way to receive your Medicare benefits. You must have both Medicare Part A and Part B to join. Medicare-approved private insurance companies administer the plans, but the plans must provide the Part A and Part B services Medicare requires.

Most plans include Part D prescription drug coverage. Many also offer benefits Original Medicare does not generally provide, including certain dental, vision, hearing, fitness, transportation, over-the-counter, or meal benefits. The exact benefits, provider network, costs, and rules vary by plan and location.

Coverage

What Does Medicare Advantage Include?

Think of Medicare Advantage as a private-plan way to receive Medicare benefits, with plan-specific costs, networks, and rules.

Included

Medicare Part A

Hospital insurance benefits, including Medicare-covered inpatient hospital and other Part A services, are provided through the Medicare Advantage plan.

Learn more about Medicare Part A.

Included

Medicare Part B

Medical insurance benefits, including Medicare-covered physician, outpatient, preventive, and other Part B services, are provided through the plan.

Learn more about Medicare Part B.

Usually included

Medicare Part D

Most Medicare Advantage plans include prescription drug coverage. If drug coverage is included, you generally use the plan's formulary and pharmacy network.

How Medicare drug formularies work.

Medicare Advantage Part C coverage overview
How It Works

How Medicare Advantage Works

You still have Medicare, but a Medicare-approved private plan becomes the primary way you receive most of your Part A and Part B benefits.

Enroll in Part A and Part B

You must have both Medicare Part A and Part B before you can join a Medicare Advantage plan.

Choose a Plan in Your Area

Available plans vary by county and service area. Plan types, premiums, networks, and benefits can differ significantly.

Use the Plan's Rules

You may use a provider network, pay copays or coinsurance, and need referrals or prior authorization for certain services.

Review the Plan Each Year

Premiums, provider networks, drug formularies, copays, and extra benefits can change from one plan year to the next.

Costs

How Much Does Medicare Advantage Cost?

There is no single Medicare Advantage price. Your total cost depends on the plan you choose and how you use care.

Part B Premium

You generally must continue paying your Medicare Part B premium to remain enrolled in Medicare Advantage. Some plans may help pay part or all of that premium.

Plan Premium

Some plans have a $0 monthly plan premium, while others charge an additional premium. A $0 premium does not mean the plan has no out-of-pocket costs.

Copays, Coinsurance and Deductibles

Plans set their own cost-sharing within Medicare rules. You may pay different amounts for primary care, specialists, hospital stays, outpatient procedures, drugs, and other services.

Annual Out-of-Pocket Limit

Medicare Advantage plans have an annual limit on what you pay for covered Part A and Part B services. After you reach the plan's limit, the plan pays 100% of covered health services for the rest of the calendar year.

Drug Costs

If your plan includes Part D, drug costs depend on the plan's formulary, pharmacy network, tiers, and Part D cost-sharing rules.

Costs Can Change Annually

Premiums, deductibles, copays, coinsurance, benefits, and networks can change each year, so annual plan review matters.

Important: The lowest premium is not automatically the lowest-cost plan. Your doctors, prescriptions, expected health care use, network access, and maximum out-of-pocket exposure can matter more than the monthly premium alone.
Plan Types

Common Types of Medicare Advantage Plans

The plan type affects how you access doctors, hospitals, specialists, and out-of-network care.

HMO

Health Maintenance Organization plans generally require you to use network providers except for emergencies, urgent care, and certain other exceptions. Referrals may be required.

PPO

Preferred Provider Organization plans have provider networks but generally allow covered out-of-network care at a higher cost when the provider agrees to treat you under the plan's rules.

SNP

Special Needs Plans are designed for people who meet specific eligibility criteria, such as certain chronic conditions, institutional status, or eligibility for both Medicare and Medicaid.

PFFS

Private Fee-for-Service plans determine how much they pay and how much you pay. Provider participation rules differ from HMO and PPO networks.

MSA

Medical Savings Account plans combine a high-deductible Medicare Advantage plan with a medical savings account. These plans generally do not include Part D drug coverage.

Access to Care

Provider Networks and Prior Authorization Matter

These are two of the biggest practical differences between Medicare Advantage and Original Medicare.

Provider Networks

Many Medicare Advantage plans use networks. HMO plans generally require network care for non-emergency services, while PPO plans usually provide some out-of-network flexibility at a higher cost.

Before enrolling: verify your primary care doctor, specialists, hospitals, and preferred facilities directly against the plan's current network.

Prior Authorization

Medicare Advantage plans may require prior authorization before certain services, supplies, or drugs are covered. The rules vary by plan and service.

Before enrolling: understand how the plan handles high-cost imaging, procedures, rehabilitation, durable medical equipment, and specialty drugs that may require approval.
Compare

Medicare Advantage vs Original Medicare

Both are ways to receive Medicare coverage, but the way you access care and pay for services can be very different.

Medicare Advantage

Coverage deliveryPrivate Medicare-approved plan provides Part A and Part B benefits.
Drug coverageMost plans include Part D.
Provider accessOften network-based, depending on plan type.
Prior authorizationMay be required for certain services or supplies.
Annual Part A/B out-of-pocket limitYes.
Extra benefitsMany plans offer benefits such as dental, vision, hearing, fitness, and other supplemental benefits.

Original Medicare

Coverage deliveryMedicare directly provides Part A and Part B coverage.
Drug coverageYou can add a separate Part D plan.
Provider accessYou can generally use any doctor or hospital in the U.S. that accepts Medicare.
Prior authorizationLess commonly required for most Original Medicare services, although certain items and services can have Medicare authorization requirements.
Annual Part A/B out-of-pocket limitNo built-in annual maximum under Original Medicare alone.
Supplement optionYou may be able to add Medigap to help with certain Original Medicare cost-sharing.
Medicare Advantage is not Medigap. Medicare Advantage replaces Original Medicare as the way you receive most Part A and Part B benefits. Medigap works alongside Original Medicare and cannot be used to pay Medicare Advantage plan cost-sharing.
Extra Benefits

What Extra Benefits Can Medicare Advantage Offer?

Many plans offer supplemental benefits beyond what Original Medicare generally covers, but availability and limits vary by plan.

Dental

Some plans provide preventive or comprehensive dental benefits, subject to the plan's provider network, allowances, copays, or benefit limits.

Vision

Plans may include routine eye exams and an allowance or coverage toward glasses or contact lenses.

Hearing

Some plans include routine hearing exams and hearing-aid benefits, often with plan-specific provider or device requirements.

Fitness and Wellness

Some plans include fitness memberships, wellness programs, or other preventive support.

Transportation and Meals

Certain plans may offer transportation or meal benefits for qualifying members or circumstances.

Over-the-Counter Benefits

Some plans provide an allowance for eligible over-the-counter health products. Amounts and eligible items vary.

Extra benefits should be evaluated after the core health coverage. A strong dental or over-the-counter benefit does not make up for a poor provider network, expensive prescriptions, or unfavorable cost-sharing for the care you actually use.
Decision Checklist

What Should You Review Before Choosing a Medicare Advantage Plan?

The best plan is the one that fits your actual doctors, prescriptions, health care needs, and budget, not simply the plan with the largest list of extras.

Check Your Care

  • Primary care doctor
  • Specialists
  • Preferred hospitals and facilities
  • Out-of-network rules
  • Referral and prior authorization requirements

Check Your Costs and Prescriptions

  • Monthly plan premium
  • Part B premium responsibility
  • Specialist and hospital cost-sharing
  • Annual maximum out-of-pocket exposure
  • Prescription formulary, tiers, and pharmacy network
FAQ

Frequently Asked Questions About Medicare Advantage

Is Medicare Advantage the same as Medicare Part C?

Yes. Medicare Advantage plans are also called Medicare Part C or MA plans.

Do I still have Medicare if I join Medicare Advantage?

Yes. You still have Medicare, but you receive most of your Part A and Part B benefits through the Medicare Advantage plan rather than directly through Original Medicare.

Do I still pay my Part B premium with Medicare Advantage?

Generally, yes. You must keep Medicare Part B and continue paying the Part B premium to remain in Medicare Advantage. Some plans may help pay part or all of the Part B premium.

Can a Medicare Advantage plan have a $0 premium?

Yes. Some plans have a $0 monthly plan premium, but you may still pay the Part B premium plus plan deductibles, copays, coinsurance, and prescription drug costs.

Does Medicare Advantage include prescription drug coverage?

Most Medicare Advantage plans include Medicare Part D drug coverage, but not every plan does. Medical Savings Account plans generally do not include Part D.

Can I use any doctor with Medicare Advantage?

It depends on the plan type. HMO plans generally require network providers for non-emergency care. PPO plans usually allow out-of-network care at a higher cost when the provider accepts the plan's terms.

Can I have Medigap and Medicare Advantage at the same time?

You cannot use Medigap to pay Medicare Advantage deductibles, copays, or coinsurance. Medigap is designed to work with Original Medicare, not Medicare Advantage.

Do Medicare Advantage benefits change every year?

They can. Premiums, cost-sharing, provider networks, drug formularies, and supplemental benefits may change each plan year, which is why reviewing your Annual Notice of Change and comparing plans can be important.

Official Medicare Sources

Medicare Advantage plan details can change each year. These official Medicare and CMS resources are the primary references for this page.

Want Help Comparing Medicare Advantage Plans?

Compare plans based on your doctors, prescriptions, hospitals, expected health care use, out-of-pocket exposure, and the extra benefits that actually matter to you.

Request Medicare Plan Information

Senior Healthcare Planning is an independent insurance agency that provides education, guidance, and enrollment assistance for Medicare-related insurance products, including Medicare Advantage, Medicare Supplement, and Prescription Drug Plans. Senior Healthcare Planning is not connected with or endorsed by the United States government or the federal Medicare program. Medicare Advantage plan availability, premiums, provider networks, drug formularies, cost-sharing, and supplemental benefits vary by plan and service area and can change each year.