Medicare Login Guide

Medicare Advantage (Part C) Explained

Updated June 3, 20266 min readReviewed against medicare.gov

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare offered by private insurers. Plans must cover everything Parts A and B cover, usually include Part D drug coverage, and often add dental, vision, hearing, and fitness benefits. In exchange, they use provider networks (HMO or PPO), may require referrals and prior authorization, and have a yearly out-of-pocket maximum that protects you from unlimited costs.

How Medicare Advantage works

When you join a Medicare Advantage plan, you still have Medicare — but the plan administers your benefits instead of the government. You generally must use the plan’s network of doctors and hospitals, and the plan sets its own copays and rules. Most plans bundle in prescription drug coverage.

The out-of-pocket maximum

Every Medicare Advantage plan must cap how much you pay out of pocket for covered Part A and B services each year. Once you hit that limit, the plan pays 100% of covered services for the rest of the year. Original Medicare on its own has no such cap.

Trade-offs to weigh

  • Pros: low or $0 premiums, extra benefits, an out-of-pocket cap, one card.
  • Cons: network restrictions, referrals, prior authorization, benefits and networks can change yearly.

Frequently asked questions

Can I use any doctor with Medicare Advantage?

Usually not. Most Medicare Advantage plans use networks. HMO plans generally require you to stay in-network (except emergencies); PPO plans let you go out-of-network at a higher cost.

Does Medicare Advantage replace Original Medicare?

You keep your Medicare, but a private plan manages your benefits. You must keep paying your Part B premium, and you cannot use a Medigap policy with a Medicare Advantage plan.

Sources

Related guides

Medicare Parts & Plan Types

Original Medicare vs. Medicare Advantage: How to Choose

Medigap (Supplement) Plans

What Is Medigap (Medicare Supplement Insurance)?

Medicare Parts & Plan Types

Medicare Part D Explained: Prescription Drug Coverage

Medicare Parts & Plan Types

Medicare Part A Explained: Hospital Insurance

Medicare Login Guide is an independent resource and is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, or any government agency. This article is for general information only — confirm current figures and your specific options at medicare.gov or by calling 1-800-MEDICARE.