Medicare Advantage bundles Parts A, B, and usually D into a single plan with extra benefits. Average premium just $18/month, with a $9,350 max out-of-pocket cap.
Medicare Advantage (MA), also called Part C, is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare. Instead of Original Medicare paying providers directly, you receive your Parts A and B coverage through an MA plan.
Key characteristics:
| Cost Component | Amount | Notes |
|---|---|---|
| Average MA plan premium | ~$18/month | In addition to Part B premium; many plans $0 |
| Part B premium (always owed) | $202.90/month | Standard; higher with IRMAA |
| Maximum OOP (in-network) | $9,350/year | CMS-set limit; individual plans often lower |
| Maximum OOP (in + out-of-network, PPO) | $14,000/year | Higher combined limit for PPO plans |
| Primary care visit copay (typical) | $0 – $30 | Varies by plan; many $0 for PCP |
| Specialist copay (typical) | $30 – $60 | HMO plans often require referral |
| Inpatient hospital (typical) | $200 – $400/day | Per-day copay for first several days |
A major draw of Medicare Advantage is coverage for benefits Original Medicare doesn't include. Common extra benefits in 2026 MA plans:
Cleanings, X-rays, fillings. Some plans cover major dental work (implants, dentures).
Eye exams, allowance for glasses or contact lenses. Typically $0–$200 annual benefit.
Hearing exams and hearing aid allowances. Important benefit Original Medicare doesn't cover.
Many plans include gym memberships (SilverSneakers, Silver&Fit, or similar) at no extra cost.
Rides to medical appointments in some plans.
Quarterly or annual allowance for OTC items at certain pharmacies or online.
| Period | When | What You Can Do |
|---|---|---|
| Initial Coverage Election Period (ICEP) | 3 months before – 3 months after your Medicare Part B start month | Enroll in MA for the first time when initially eligible |
| Annual Enrollment Period (AEP) | Oct 15 – Dec 7 | Switch plans, join, or drop MA; coverage starts Jan 1 |
| MA Open Enrollment Period (OEP) | Jan 1 – Mar 31 | One switch per year: change MA plans or return to Original Medicare |
| Special Enrollment Periods (SEPs) | Triggered by qualifying events | Move, plan termination, Medicaid enrollment, etc. |
| Feature | Medicare Advantage | Original Medicare |
|---|---|---|
| Provider network | Restricted (HMO/PPO) | Any Medicare-accepting provider nationwide |
| Referrals needed | Often (HMO) | No referrals required |
| Extra benefits | Dental, vision, hearing often included | Not included (separate coverage needed) |
| Prescription drugs | Usually included (MAPD) | Requires separate Part D plan |
| Out-of-pocket cap | Yes — $9,350 max (in-network) | No cap (Medigap can fill this) |
| Supplemental (Medigap) | Cannot use Medigap with MA | Medigap supplements Original Medicare |
| Travel coverage | Limited to plan network (emergency only out-of-network) | Nationwide at any Medicare provider |
| Cost predictability | Copays per service, OOP cap protects | 20% coinsurance (no cap without Medigap) |
Use our Advantage vs. Original Medicare calculator to estimate which option saves you more based on your health usage.