Medicare Advantage

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Quick answer

Medicare Advantage is private, Medicare-approved insurance that delivers your Part A and Part B benefits, usually bundled with Part D drugs and extras like dental and vision. In 2026, CMS reports about 34 million Americans are enrolled, more than half of all people with Medicare.

Medicare Advantage is the private alternative to Original Medicare. Here is what it covers, how it works, and how to decide if it fits you.

How does Medicare Advantage work?

When you join a Medicare Advantage plan, a private insurer approved by CMS takes over your Medicare benefits. You keep paying your Part B premium, and the plan handles your Part A and Part B care, usually adding Part D drug coverage and extras. You use the plan's network of doctors and hospitals, pay copays at the point of care, and are protected by an annual out-of-pocket maximum. Plans renew yearly, and benefits can change, so it pays to review your coverage each fall. Questions? Call 1-800-MEDIGAP (1-800-633-4427).

What does Medicare Advantage cover?

Every Medicare Advantage plan must cover everything Original Medicare covers, including hospital stays, doctor visits, lab work, and preventive care. Beyond that, most plans add prescription drugs, routine dental, vision, hearing aids, fitness memberships, and over-the-counter allowances that Original Medicare does not include. Some plans offer transportation, meal delivery after a hospital stay, or a Part B premium giveback. Benefits vary by plan and location, so confirm the specifics before enrolling. A licensed advisor at 1-800-MEDIGAP can match the extras you want to plans available in your ZIP code.

Is Medicare Advantage right for you?

Medicare Advantage works well if you want low premiums, bundled benefits, and an out-of-pocket cap, and you are comfortable using a network. It may be a weaker fit if you travel often, want any-doctor freedom, or take specialty drugs that need prior authorization. The decision hinges on your health, budget, and preferences, not on advertising. Because the trade-offs are personal, the free advisors at 1-800-MEDIGAP review your doctors, medications, and priorities before recommending a plan, with no pressure and no cost to you.

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Frequently asked questions

What is the main downside of Medicare Advantage?+

The biggest downside is restricted access. Most plans use networks, so seeing out-of-network doctors costs more or is not covered, and many services require prior authorization that can delay care. Coverage is also mostly local, which can complicate travel. Weigh these against the lower premiums and extra benefits.

Can I keep my own doctor with Medicare Advantage?+

Only if your doctor is in the plan's network. HMO plans generally require in-network providers; PPO plans allow out-of-network care at higher cost. Always verify your doctors and hospitals are in-network before enrolling. A 1-800-MEDIGAP advisor can check this for you for free.

How much does Medicare Advantage cost?+

Many plans have a $0 monthly premium, but you still pay your Part B premium ($185 in 2026 for most), plus copays and coinsurance when you use care. Your total cost depends on how often you need services and your plan's out-of-pocket maximum, which is capped at $9,250 in-network in 2026.

Is Medicare Advantage good or bad?+

Neither universally. Medicare Advantage is a good fit for people who value low premiums and bundled benefits and don't mind a network, and a poor fit for those who want any-doctor freedom or travel often. The right answer depends on your situation. Call 1-800-MEDIGAP for an honest assessment.

How do I switch or enroll in Medicare Advantage?+

You can join during your Initial Enrollment Period at 65, the Annual Election Period (October 15 to December 7), or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Special Enrollment Periods cover qualifying life events. Call 1-800-MEDIGAP (1-800-633-4427) to confirm your dates and compare plans.

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