One plan in place of Original Medicare
A Medicare Advantage plan is offered by a private insurance company that Medicare has approved and that must follow Medicare's rules. Instead of the federal government paying your claims under Original Medicare, the plan handles your Part A and Part B benefits, and most plans include Part D drug coverage as well. The plan must cover at least what Original Medicare covers, though it can set its own costs and rules for getting care.
To join, you need both Part A and Part B, and you keep paying your Part B premium. Some plans charge their own premium on top of that; some help pay all or part of the Part B premium, but not in every area.
Common plan types
HMO
Health Maintenance Organization. You generally get care from doctors and hospitals in the plan's network. Emergency care and urgent care while you are away from home are covered outside it.
PPO
Preferred Provider Organization. Staying in the network costs less. You can generally see providers outside it for covered services, but you will usually pay more.
Special Needs Plan
For people with certain severe or chronic conditions, certain care needs, or both Medicare and Medicaid. These plans shape their benefits, doctors and drug lists around that group.
Other types
Private Fee-for-Service plans and Medicare Medical Savings Account plans also exist.
How costs work
Each plan sets its own premium, deductibles and copays, and what you pay the plan can only change once a year, on January 1. Unlike Original Medicare, every Medicare Advantage plan has a yearly limit on what you pay out of pocket for covered services. Once you reach it, the plan pays 100% of covered care for the rest of the calendar year. Going outside the network for care that is not an emergency can cost more, or may not be covered at all.
Questions to ask before you join
Are your doctors, hospitals and pharmacies in the network? Are your prescriptions on the plan's drug list? Which services need approval in advance? What is the yearly out-of-pocket limit? If you have coverage from an employer or union, ask its benefits office first, because joining a Medicare Advantage plan can end that coverage, sometimes for your spouse and dependents too, and you may not be able to get it back.
Plans can also change from one year to the next, and an insurance company can decide to leave Medicare. If your plan stops participating, you would choose another plan or go back to Original Medicare. For how this path compares with Original Medicare and a supplement, see Medicare Advantage vs Medigap; for the dates you can join or switch, see when you can change Medicare plans.
Common questions
Do I still pay the Part B premium with Medicare Advantage?
Does Medicare Advantage include drug coverage?
Can I have a Medigap policy with Medicare Advantage?
Is there a limit on what I pay?
Does it cost anything to talk with you?
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Medicare.gov: Your health plan options
Medicare.gov: Understanding health plan costs
Medicare.gov: Your coverage options
Medicare.gov: Medicare costs
Medicare.gov: What Part B covers
Medicare.gov: How Medigap works
Medicare.gov: HMO plans
Medicare.gov: PPO plans
Medicare.gov: Special Needs Plans
SHIP Medicare FAQ (SHIP National Technical Assistance Center)
Last reviewed October 2026. Medicare rules, dates and dollar amounts can change each year; Medicare.gov has the official details.