Medicare Advantage

A plan can look excellent in a brochure and still be a poor fit if your doctors, prescriptions or cost exposure do not line up.

Written and reviewed by James KauferIndependent Medicare Agent · NPN 15374945Updated August 19, 2026

What Medicare Advantage actually changes

Medicare Advantage, also called Part C, is an alternative way to receive Medicare-covered Part A and Part B benefits through a private plan approved by Medicare. Most plans also include Part D prescription coverage.

Five plan details to review every year

  1. Provider network: verify doctors, hospitals and specialists rather than assuming last year’s network is unchanged.
  2. Prescription formulary: check your exact drugs, tiers, preferred pharmacies and utilization rules.
  3. Cost-sharing: look beyond premium to hospital copays, outpatient surgery, imaging, specialists and other likely services.
  4. Maximum out-of-pocket: this caps your cost for covered Medicare services for the year, but the amount varies by plan.
  5. Prior authorization: understand which services may require plan approval before coverage.
James Kaufer reviewing Medicare Advantage coverage with a client
A Medicare Advantage comparison should be built around the providers, prescriptions and services you are likely to use.

$0 premium does not mean $0 exposure

You generally continue paying the Part B premium and may owe plan copays or coinsurance when you use care. Some plans charge an additional premium; others may have a $0 plan premium. Supplemental benefits also vary by plan and area.

Where hospital indemnity can enter the conversation

Some people with Medicare Advantage evaluate hospital indemnity insurance as a separate way to address specified hospital or medical-event exposure. It is not Medicare coverage, and whether it makes sense depends on the policy benefits, cost and the exposure you are trying to manage.

Learn how hospital indemnity works →

Frequently asked questions

Do all Medicare Advantage plans have networks?

Plan structures differ. HMOs and PPOs commonly use networks, while other Medicare Advantage plan types can work differently.

Do Medicare Advantage plans require prior authorization?

Medicare says people in Medicare Advantage typically need prior authorization for certain services or supplies. The specific rules vary by plan.

Do I still pay Part B in Medicare Advantage?

Yes. You must have Part B and keep paying your Part B premium to stay in a Medicare Advantage plan.

Primary sources

This guide is based on current information from Medicare.gov and CMS. Rules can change, so verify time-sensitive details before acting.