Medicare Advantage Plans | Medicare Part C

Written by
Rachel Christian
Rachel Christian
Financial Writer and Certified Educator in Personal Finance
Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.
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Edited By
Matt Mauney
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
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Reviewed By Bob Glaze
Published: April 28, 2020
Updated: March 2, 2023
12 min read time
This page features 14 Cited Research Articles

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How Medicare Advantage Plans Work

Medicare Advantage, or Part C, is an “all-in-one” alternative to Original Medicare (Part A and Part B). These plans are offered by government-approved private insurance companies Medicare later reimburses.

Instead of juggling coverage from multiple plans, Medicare Advantage offers all benefits within a single plan.

Medicare Advantage plans may also include Part D drug coverage, vision, dental and hearing benefits.

By law, Medicare Advantage plans must provide the same level of coverage as Original Medicare.

No matter what Medicare Advantage plan you select, you’re guaranteed emergency and urgently needed care.

Types of Medicare Advantage Plans

Health Maintenance Organization Plans: Enrollees must use doctors, pharmacies, hospitals and other medical facilities within the plan’s network. This rule does not apply to emergency or urgent care services. Most HMOs also require a referral from your primary care doctor to see a specialist. Prescription drugs are covered in most cases.
Preferred Provider Organization Plans: Enrollees pay less for doctors, pharmacies, hospitals and other medical facilities within the plan’s preferred network. Services outside the network usually cost more. You don’t need a referral to see a specialist. Prescription drugs are covered in most cases.
Private Fee-for-Service Plans: There may or may not be a provider network. Doctors and medical providers outside of the network can choose to accept or deny PFFS plan coverage on a service-by-service, patient-by- patient basis. You don’t need a referral to see a specialist. Prescription drugs may or may not be covered.
Special Needs Plans: Enrollees with specific diseases, certain health care needs or limited incomes receive special, tailored coverage. To qualify, you must meet certain criteria. You will likely be required to have a primary care doctor within the plan’s network. All plans must provide prescription drug coverage.

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Who Is Eligible for Medicare Part C?

Anyone who is already enrolled in Original Medicare is eligible for Medicare Part C.

To qualify, you must live in the plan’s service area and be a U.S. citizen, U.S. national or lawfully present in the U.S. In 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, according to the Kaiser Family Foundation.

Who is eligible for Medicare Advantage plans? - Featuring Anne Novak — Learn more about who's eligible for Medicare Advantage plans from Anne Novak, who is licensed in Life and Annuities, Sickness, Accident and Health by the Nebraska Department of Insurance.

When Can You Enroll?

You can only join, switch, or drop a Medicare Advantage plan during specific enrollment periods.

Medicare Advantage Enrollment Periods

Initial Enrollment: You can enroll in a Medicare Advantage plan when you first become eligible for Medicare around your 65th birthday. Initial enrollment is a seven-month window that begins three months before your birthday and extends three months after your birth month.
Medicare Open Enrollment: Each year, from Oct. 15 to Dec. 7, anyone enrolled in any Original Medicare plan can join, switch or drop coverage. If you have a Medicare Advantage plan, you can make changes or buy a new policy. New coverage will begin Jan. 1.
Medicare Advantage Open Enrollment: Different from Medicare Open Enrollment, this period applies specifically to people who already have a Medicare Advantage plan. Medicare Advantage Open Enrollment runs from Jan. 1 through March 31. During this period, you can switch to a different Medicare Advantage plan or switch back to Original Medicare and add a Medicare Part D drug plan.
General Enrollment: If you miss the initial enrollment period for Medicare, you can sign up for Original Medicare from Jan. 1 to March 31 each year. Your new coverage will take effect July 1. After signing up for Medicare Parts A and B during this time, you may then enroll in a Medicare Advantage plan from April 1 through June 30. Your Medicare Advantage plan coverage will then start on July 1.

What Is Covered Under Medicare Advantage Plans?

Medicare Advantage benefits vary widely from plan to plan.

All Medicare Advantage plans must include:

At least the same level of care as Medicare Part A and B
Emergency care
Urgent care
Hospice services

More Medicare Advantage plans now offer additional services, with over 90% of plans offering vision, dental, hearing and fitness, according to a November 2022 Kaiser Family Foundation report.

In 2022, most Medicare Advantage enrollees have access to additional nonmedical supplemental benefits. Some options include coverage for a meal benefit, acupuncture and transportation.

Medicare Advantage plans may cover additional benefits such as:

Dental
Vision
Transportation to doctor visits
Hearing aids
Home modifications
Prescription drugs
Over-the-counter drugs
Adult day care services
Wellness programs

What is the benefit of a Medicare Advantage Plan over Original Medicare? - Featuring Terry Turner — RetireGuide's senior financial writer and financial wellness facilitator Terry Turner lists some of the services included in Medicare Advantage plans that aren't available through Original Medicare.

Costs of Medicare Part C

Most Medicare Advantage plans include a monthly fee, or premium. Some premium-free plans also exist.

The average 2023 Medicare Advantage premium is about $18 a month, according to the U.S. Centers for Medicare and Medicaid Services.

You must still pay your monthly Part B premium each month in addition to any Medicare Advantage costs.

The Part B premium is $164.90 for 2023, down from $170.10 in 2022.

Higher income households pay more for the Part B premium. Low-income households may qualify for discounts.

Did You Know?

If a plan provider claims your service isn’t medically necessary, you may have to pay all costs out-of-pocket. However, you have the right to appeal the decision.

Source: U.S. Department of Health & Human Services

Pros and Cons of Medicare Advantage Plans

Medicare Advantage plans give people an alternative to Original Medicare — but Part C comes with some drawbacks.

Pros and Cons of Medicare Advantage

Advantages

All-in-one inclusive benefit plan
May offer no-cost premiums or deductibles
May offer dental, vision and hearing benefits
Annual limit on out-of-pocket costs

Disadvantages

Coverage is limited to in-network providers
Plans may cost more than Original Medicare
Coverage limited to specific geographical area
Can’t be combined with a Medicare supplemental insurance plan

Learn More About the Pros & Cons of Medicare Advantage

How often do people typically change their Medicare Advantage plans? - Featuring Tom Parkin — Learn why most people tend to stick with their Medicare Advantage plans over time, courtesy of Tom Parkin, a Medicare expert who has more than a decade of experience in the insurance industry.

Frequently Asked Questions About Medicare Advantage Plans

What is the difference between Medicare Advantage and Medigap?

Medigap and Medicare Advantage are both designed to fill coverage gaps in Original Medicare. However, you pick either Medigap or Medicare Advantage — you can’t have both. Medigap is only for Original Medicare recipients.

Where can I compare Medicare Advantage plans?

The Plan Finder tool at Medicare.gov is the easiest way to compare all the local Medicare Advantage plans in your area.

Can I see any doctor with a Medicare Advantage plan?

Typically, you must use doctors and hospitals in your Medicare Advantage plan network. Seeing a medical professional outside this network will cost you.

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