Medicare Advantage (Part C)

What it is

Medicare Advantage (also called "Part C") is an alternative to Original Medicare, offered by private insurance companies approved by Medicare. Instead of the federal government paying your hospital and doctor bills directly (Original Medicare), you enroll in a private plan that takes over that role.

You're still in the Medicare program — you still have to be enrolled in Parts A and B — you just receive your benefits through the private plan instead.

What's typically included

• All of Part A (hospital) and Part B (medical) coverage
• Usually Part D (prescription drug) coverage built in
• Often extra benefits — dental, vision, hearing, fitness (Silver Sneakers), transportation to medical appointments, OTC allowance
• An annual out-of-pocket maximum (something Original Medicare doesn't have)

How it works in real life

Most Advantage plans use a network — HMO (you stay in-network for almost everything) or PPO (you can go out-of-network for higher cost). You pay copays for visits ($0-$50 typical for primary care, $30-$100 for specialists). Some services need referrals or pre-authorization. Premium ranges from $0/month to $200+, with $0 plans being most common (the carrier gets a payment from CMS that covers the premium for you).

Who it's a good fit for

• You want lower (or zero) monthly premiums
• Your preferred doctors and hospitals are in the plan's network
• You like having extra benefits (dental, vision, gym) bundled in
• You don't travel a lot outside your service area
• You're comfortable with copays per visit (vs. paying a higher premium for predictable coverage)

Who it's NOT a good fit for

• You want maximum doctor freedom — any provider that accepts Medicare, anywhere in the country
• You travel frequently and want coverage that works the same everywhere
• Your specific doctors aren't in any local Advantage network
• Your specialty medications aren't on the local Advantage formularies
• You'd rather pay a higher predictable monthly premium than face copays per visit

How we help

Before recommending any Advantage plan, we verify that your specific doctors are in the plan's network and your specific prescriptions are on the formulary. We compare every plan available in your county side-by-side — premiums, max out-of-pocket, networks, drug coverage, extra benefits — and explain what actually fits your situation.

→ See how Medicare Supplement compares · → Part D guide · → Back to Medicare 101