Medicare Advantage, explained
One plan for your hospital, medical, and usually drug coverage, often with extras. Here’s how it works and how to pick a plan that fits.
What is Medicare Advantage?
Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company approved by Medicare. Instead of using Original Medicare (Parts A and B) on its own, one plan covers your hospital and medical care. Most plans also include Part D prescription drug coverage.
You still have Medicare, and you still pay your Part B premium. The plan sets its own copays, network, and extra benefits within rules set by Medicare.
What Medicare Advantage plans can include
- Hospital and medical coverage, everything Original Medicare covers
- A yearly out-of-pocket maximum for in-network care. Original Medicare has no cap. For 2027, in-network maximums can be as high as $9,850, and many local plans are far lower.
- Prescription drug coverage on most plans
- Extras such as routine dental, vision, hearing aids, fitness memberships, and over-the-counter allowances. These vary widely by plan.
- A Part B giveback on some plans, which lowers the Part B premium taken from your Social Security check
HMO vs. PPO: the choice that matters most
| HMO | PPO | |
|---|---|---|
| Network | Must use in-network doctors except emergencies | Can see out-of-network doctors at a higher cost |
| Referrals | Often required for specialists | Usually not required |
| Premiums | Often lower | Sometimes higher |
| Best for | People whose doctors are all in one local system | People who want flexibility or travel |
How many plans are available near you?
For 2027, Greene County (Springfield) has 38 plans, Cape Girardeau County has 20, and Shawnee County (Topeka) has 27. Comparing that many plans by hand is hard. Comparing them is what we do every day. Find your county →
Source: CMS CY2027 Landscape file, Sept 2026. Individual plans, excluding Special Needs Plans.
Who Medicare Advantage tends to fit
Medicare Advantage often works well if your doctors are in a local network, you want low or $0 premiums, and you value extras like dental and vision. It can be a poorer fit if you travel often, spend part of the year in another state, or want to see any doctor in the country. In those cases, look at a Medicare Supplement.
Frequently asked questions
Can I keep my doctor with Medicare Advantage?
Only if your doctor is in the plan’s network, or if you choose a PPO and accept higher out-of-network costs. We check your doctors before recommending any plan.
Is a $0-premium plan really free?
A $0-premium plan has no monthly plan premium, but you still pay your Medicare Part B premium. You also pay copays, coinsurance, and deductibles when you use care.
Can I switch from Medicare Advantage back to Original Medicare?
Yes. You can switch during the Annual Enrollment Period (Oct 15 – Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31). Buying a Medigap policy after that may require health questions. See our enrollment periods guide.
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