Medicare Advantage is the most popular way to get Medicare coverage. But not all plans are created equal. Here's everything you need to know to choose wisely.
Medicare Advantage is an alternative way to receive your Medicare benefits — through a private insurer approved by Medicare.
When you enroll in a Medicare Advantage plan, you keep your Medicare Parts A and B. The private insurer administers your benefits instead of the government — but Medicare sets the rules.
By law, every Medicare Advantage plan must cover everything Original Medicare covers. Most plans also bundle Part D drug coverage and add extra benefits like dental, vision, and hearing.
Most MA plans have a network of doctors, hospitals, and specialists. Staying in-network typically means lower costs. Some plan types (PPO) allow out-of-network care at higher cost.
Instead of Medicare's deductibles and 20% coinsurance, you pay the plan's copays and coinsurance. Every plan has an annual out-of-pocket maximum — a financial safety net Original Medicare lacks.
Key fact: Over 33 million Americans — more than half of all Medicare beneficiaries — are now enrolled in Medicare Advantage plans. Enrollment has grown every year since 2004.
The plan type determines how you access care and how much flexibility you have. HMO and PPO are by far the most common.
Best for: People who have a primary care doctor they trust, prefer lower costs, and don't travel frequently.
A side-by-side look at the key differences to help you decide which approach fits your life.
Neither option is universally better. The right choice depends on your doctors, medications, budget, and how much you value flexibility vs. cost savings. Use the Medicare Plan Finder to compare real plans in your area.
The monthly premium is just one piece of the puzzle. Here are all the cost components you need to understand.
What you pay each month to be enrolled in the plan. Many MA plans have $0 premiums — but you still pay your Part B premium ($202.90/month in 2026).
A $0 premium plan isn't necessarily the best value. Look at total estimated annual cost.
The amount you pay out of pocket before the plan starts sharing costs. Some MA plans have $0 deductibles; others have separate deductibles for medical and drug coverage.
Check whether the deductible applies to all services or just specific ones (like drugs).
A fixed dollar amount you pay for a specific service — for example, $10 for a primary care visit or $45 for a specialist. Copays vary by service type and plan.
Specialist copays can add up quickly if you have multiple conditions. Compare these carefully.
Your percentage share of costs after the deductible. For example, 20% coinsurance on a $10,000 hospital stay means you pay $2,000 (up to your out-of-pocket maximum).
Coinsurance for hospital stays and chemotherapy can be significant — check these rates.
The most you'll pay in a calendar year for covered services. Once you hit this limit, the plan pays 100%. In 2024, the maximum allowed MOOP is $8,850 for in-network services.
This is your financial safety net. Lower MOOP = more protection. In 2026, the maximum allowed MOOP is $9,250 in-network ($13,900 combined in- and out-of-network). Original Medicare has NO out-of-pocket maximum.
Plans organize covered drugs into tiers (1–5), with Tier 1 (generics) being cheapest and Tier 5 (specialty drugs) being most expensive. Your cost depends on which tier your drug falls into.
Always check your specific medications against the plan's formulary before enrolling.
Most Medicare Advantage plans include benefits Original Medicare doesn't cover. Coverage limits vary — always read the plan details.
Routine eye exams, eyeglasses, and contact lens allowances. Coverage limits vary widely.
Hearing exams and hearing aid allowances. Some plans offer significant hearing aid benefits.
Preventive dental (cleanings, X-rays) is common. Comprehensive dental (crowns, dentures) varies by plan.
Programs like SilverSneakers or gym memberships. Very common in MA plans.
A quarterly or annual allowance for over-the-counter health items at participating stores.
Rides to medical appointments. Availability and limits vary significantly by plan and area.
Don't choose a plan based on extras alone. A plan with great dental benefits but a narrow doctor network or high specialist copays may cost you more overall. Prioritize network and drug coverage first.
Use this prioritized checklist when evaluating plans side by side.
CMS rates every Medicare Advantage plan on a 1–5 star scale based on quality of care, member satisfaction, and health outcomes. Always check a plan's star rating before enrolling.
Aim for 4 stars or higher. Plans with 5 stars can be joined at any time during the year (not just during enrollment periods). Star ratings are published each fall at Medicare.gov.
Now that you understand how Medicare Advantage works, take your next step.
Disclaimer: Medicare Made Clear, Made Simple with AI is an independent educational website not affiliated with the U.S. government, Medicare, or any insurance company. Cost figures cited are for 2024 and may change annually. Always verify plan details at Medicare.gov.