Medicare Advantage Plans

Medicare Advantage, also called Medicare Part C, is a private-plan way to receive your Medicare Part A and Part B benefits. Medicare Advantage plans are offered by Medicare-approved private companies and must follow Medicare rules. Most plans include Medicare Part D prescription drug coverage, and some plans offer additional benefits not routinely covered by Original Medicare.

There is no single Medicare Advantage plan that is right for everyone. Costs, provider networks, drug formularies, service areas, and extra benefits can differ substantially from one plan to another.

How Medicare Advantage works

You must have Medicare Part A and Part B to join a Medicare Advantage plan. You continue to pay your Part B premium while enrolled.

The plan becomes the primary way you receive your Medicare-covered Part A and Part B services. Plans must cover medically necessary services that Original Medicare covers, although plan rules can affect where and how you receive care.

Most Medicare Advantage plans include prescription drug coverage. If a Medicare Advantage HMO or PPO does not include drug coverage, you generally cannot add a separate stand-alone Part D plan, so verify the drug-coverage rules before enrolling.

Common Medicare Advantage plan types

HMO

A Health Maintenance Organization plan generally requires you to use providers and facilities in the plan’s network for non-emergency care. Emergency care, out-of-area urgent care, and certain dialysis services are exceptions. HMOs may require referrals or prior authorization.

PPO

A Preferred Provider Organization plan has a provider network, but you can generally use out-of-network providers for covered services if they accept the plan. You usually pay more when you go out of network.

SNP

Special Needs Plans are Medicare Advantage plans designed for people who meet specific eligibility requirements. Types include Dual Eligible SNPs for certain people who have both Medicare and Medicaid, Chronic Condition SNPs, and Institutional SNPs. SNPs include Part D drug coverage.

PFFS and MSA

Private Fee-for-Service and Medical Savings Account plans are additional Medicare Advantage plan types with different provider and drug-coverage rules. Availability varies by area.

What Medicare Advantage can cost

Your costs depend on the specific plan. You may have:

• a monthly plan premium, which can be $0 for some plans;
• your regular Part B premium;
• deductibles;
• copayments;
• coinsurance; and
• different costs for in-network and out-of-network services.

Every Medicare Advantage plan has a yearly limit on what you pay out of pocket for covered Part A and Part B services. After you reach your plan’s applicable limit, you pay nothing for covered Part A and Part B services for the rest of that year.

A $0 plan premium does not mean the plan has no costs. Review the full cost structure.

Provider networks matter

Before enrolling, verify that the doctors, hospitals, specialists, and facilities you want to use participate in the plan’s current network.

Networks can change. A provider accepting Medicare does not automatically mean the provider participates in every Medicare Advantage plan.

Also check whether the plan requires referrals or prior authorization for services you expect to use.

Prescription coverage and formularies

Most Medicare Advantage plans include Part D drug coverage. Review:

• whether each prescription is on the plan’s formulary;
• the drug tier;
• the pharmacy network;
• whether your pharmacy is preferred or standard;
• prior-authorization requirements;
• step-therapy requirements; and
• quantity limits.

Do not compare Medicare Advantage plans based only on the monthly premium.

Extra benefits

Some Medicare Advantage plans offer benefits that Original Medicare does not routinely cover, such as certain dental, vision, hearing, fitness, transportation, or other supplemental benefits.

Benefits vary by plan and may have limits, networks, prior authorization, frequency rules, or other conditions. Review the plan’s Evidence of Coverage and other current plan documents rather than assuming a benefit is included.

Star Ratings

Medicare uses a 1-to-5-star system to help consumers compare Medicare Advantage and drug plans on quality and performance measures.

Star Ratings are one useful comparison factor, but they do not tell you whether your doctors are in network, whether your drugs are covered, or what your total costs will be. Verify all of those items separately.

When can you join or change a Medicare Advantage plan?

Enrollment changes are allowed during specific Medicare enrollment periods. These can include your Initial Enrollment Period, the Annual Enrollment Period, the Medicare Advantage Open Enrollment Period, and certain Special Enrollment Periods.

The exact action you can take depends on the enrollment period and your circumstances.

Medicare Advantage comparison checklist

Before choosing a plan, confirm:

1. Are my doctors and hospitals in network?
2. Are my prescriptions on the formulary?
3. What are my pharmacy options?
4. What will I pay for my most-used services?
5. What is the plan’s annual out-of-pocket limit?
6. Are referrals or prior authorization required?
7. Does the plan cover me when I travel?
8. Which supplemental benefits would I actually use?
9. What do the current plan documents say?
10. Is the plan available in my county and service area?

Compare Medicare Advantage options

Wise Owl Insurance Group can help you review Medicare Advantage information available for your location. Plan availability, benefits, costs, networks, formularies, Star Ratings, and service areas vary by plan and year.

Wise Owl Insurance Group is not connected with or endorsed by the U.S. government or the federal Medicare program. For information about all available Medicare options, use Medicare.gov or call 1-800-MEDICARE.

Last reviewed: September 22, 2026.