Medicare Part C – Medicare Advantage
Medicare Advantage plans bundle Part A, Part B, and usually Part D into a single plan offered by private insurers. They must cover everything Original Medicare covers, and often offer extra benefits.
What Do Medicare Advantage Plans Cover?
All Medicare Advantage plans must cover everything Original Medicare covers (except hospice, which stays under Part A). Many also offer:
- Prescription drug coverage (Part D)
- Routine dental, vision, and hearing services
- Fitness programs (like gym memberships)
- Health and wellness programs
- Transportation to medical appointments (some plans)
Types of Medicare Advantage Plans
Health Maintenance Organization — you must use doctors within the plan's network, except in emergencies.
Preferred Provider Organization — you can visit out-of-network providers, but pay less staying in-network.
Private Fee-for-Service — the plan sets how much it pays and how much you pay when you receive care.
Special Needs Plans — designed for people with specific diseases, chronic conditions, or those in nursing homes.
Understanding Your Costs
Medicare Advantage plans replace Original Medicare's cost structure with their own. Every plan is different — here's what to look for when comparing.
Monthly Premium
In addition to your Part B premium, you may pay a separate monthly premium for your Medicare Advantage plan. Many plans advertise a $0 plan premium — but you still owe your Part B premium regardless. A $0 premium plan is not necessarily the best value once you factor in other cost-sharing.
Deductible
Some Medicare Advantage plans have a medical deductible — an amount you pay out-of-pocket before the plan starts sharing costs. This is separate from the Part B deductible. Deductibles vary widely: some plans have $0, others may have $500 or more. Drug plan deductibles (if included) are tracked separately.
Copayments
A copay is a fixed dollar amount you pay for a specific service — for example, $10 for a primary care visit, $45 for a specialist, or $350 for an ER visit. Copays apply each time you use that service. Plans with lower premiums often have higher copays, so consider how frequently you see doctors when comparing.
Coinsurance
Coinsurance is your percentage share of a cost after any deductible is met — for example, 20% of a hospital stay or outpatient procedure. Unlike a fixed copay, coinsurance scales with the cost of the service, so a high-cost hospitalization can result in significant out-of-pocket expense before you hit your maximum.
Maximum Out-of-Pocket (MOOP)
This is one of the most important numbers on any Medicare Advantage plan. The MOOP is the most you'll pay in a calendar year for covered Part A and Part B services. Once you reach it, the plan pays 100% for the rest of the year. In 2026, the federal limit is $9,250 for in-network costs. Some plans set their MOOP lower — a lower MOOP means more financial protection if you have a serious illness or hospitalization. Note: drug costs and out-of-network costs may not count toward the MOOP depending on the plan.
Eligibility & Enrollment
To enroll in a Medicare Advantage plan, you must:
- Be enrolled in both Medicare Part A and Part B
- Live in the plan's service area
You can enroll during your Initial Enrollment Period, the Annual Election Period (Oct 15 – Dec 7), or a Special Enrollment Period.
What About Hospital Inpatient Copays?
A single inpatient stay on a per-day plan can run into the low thousands. If you want to reduce that exposure, a separate insurance product called hospital indemnity pays you a fixed cash benefit per day of qualifying hospitalization, which you can apply against your copays.
Learn more about hospital indemnity →