Medicare Advantage Plans
Medicare Advantage Plans are offered by private insurance companies and provide all of your Part A and Part B benefits (many also include prescription coverage)
This guide contains useful information about Medicare Advantage (Medicare Part C) and offers an easy to understand overview of the benefits and conveniences of these plans. Medicare Advantage plans can be a cost-effective health insurance option as Medicare Advantage plans can have lower out of pocket costs, reduced deductibles and maximum out of pocket limits (MOOPs) providing predictability and potential savings.
Quick answer
Medicare Advantage, also known as Medicare Part C, is offered through private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS). Medicare Advantage plans offer an alternative way to receive Medicare Part A and Part B benefits. Some plans also include Part D prescription drug coverage. Coverage and medical-necessity requirements vary by plan, so check the plan’s Evidence of Coverage or contact the plan before receiving a service.
Depending on the plan and service area, Medicare Advantage plans may offer one or more of the following additional benefits:
Some Medicare Advantage Special Needs Plans for people with both Medicare and Medicaid, or people with Medicare who have a qualifying chronic condition and meet other plan requirements, may include allowances for certain qualifying members that may help pay for healthy groceries and/or other special supplemental benefits, such as one or more of the following:
Medicare Advantage plans may also have low monthly premiums and may help enrollees save money on one or more of the following:
*There may not be a plan in your area that has these benefits in one plan
**Allowance amounts cannot be combined with other benefit allowances. Limitations and restrictions may apply.
***Benefit(s) mentioned may be or are part of a Special Supplemental Benefits (program) for the Chronically Ill (SSBCI). You may qualify if you have a high risk for hospitalization and/or require intensive care coordination for one of, but not limited to, the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply. To learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to the plan’s Evidence of Coverage.
For UnitedHealthcare Chronic Condition Special Needs Plans (C-SNP), the healthy food benefit is a special supplemental benefit available only to chronically ill enrollees with a qualifying condition, such as diabetes, chronic heart failure and/or cardiovascular disorders, who also meet plan criteria indicating they are at high risk for hospitalization and eligible for intensive care coordination.
For UnitedHealthcare Dual Eligible Special Needs Plans (D-SNP), the healthy food and utilities benefits are special supplemental benefits available only to chronically ill enrollees with a qualifying condition, such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol, who also meet plan criteria indicating they are at high risk for hospitalization and eligible for intensive care coordination. There may be other qualifying chronic conditions not listed. If you use this benefit for certain utilities, it may be considered income for housing assistance. Check with your housing authority for details.
Plan details
Medicare Advantage Plans typically use HMO, PPO or PFFS networks. Below is the list of the Medicare Advantage Networks, and how they work.
These networks have a specific network of select physicians and may require referral from a primary care physician before a patient can see a specialist. HMOs also provide additional benefits, like coverage for deductibles and more.
A preferred provider organization allows customers to save money when they use a physician inside the plan's network. Customers are still able to see doctors outside the network, but might have to pay a higher cost.
Private Fee-For-Service plans work similarly to that of Original Medicare, but the plan determines how much it will pay the physician or facility and how much the patient will pay out-of-pocket.
A HMO “Point-of-Service" plan operates like a HMO but allows for some services to be covered by an out-of-network physician often for a higher copayment or coinsurance.
A Medical Savings Account plan combines a high-deductible plan with a bank account where money is deposited by the plan to be used for health care services.
Bear in mind that some plans may change networks, so it’s important to review your plan annually to ensure it still meets your health-care needs and fits within your financial circumstances.
Benefits and considerations
Consider your health needs and financial position when deciding on coverage. Typically, Medicare Advantage plans are good for individuals seeking a comprehensive, convenient health care experience because they cover Medicare Parts A & B benefits and, potentially, offer other benefits and access to health and wellness programs.
You should also carefully consider the accessibility of health care provider networks since Medicare Advantage has network restrictions. People living in areas with more provider networks will have more choices, and greater accessibility to plan services, when it comes to Medicare Advantage.
*There may not be a plan in your area that has these benefits in one plan
Benefits
Medicare Advantage plans cover Medicare Part A and Part B benefits. Depending on the plan and service area, they may also include benefits not offered by Original Medicare, such as vision, hearing, and dental services.
Covered services depend upon plan and provider. This means that not all plans will, for example, offer coverage for prescription drugs or health and wellness services.
In addition, Medicare Advantage typically does not offer:
Compare coverage paths
If you have enrolled in Original Medicare, you’re probably aware that there are coverage gaps (often referred to as “holes”) that can be filled by opting for a Medicare Advantage or Medicare Supplement Insurance plan. Medicare Advantage plans, which are approved by CMS and offered by private insurance companies, offer the same benefits as Medicare Parts A and B and may cover services not offered under Original Medicare, like fitness programs.
Medicare Supplement Insurance, also known as Medigap, offers coverage designed to fill the gaps in Original Medicare. Medigap policies help pay some of the costs not covered by Original Medicare. If you have an Original Medicare plan and a Medigap policy, Medicare and your Medicare Supplement Insurance plan will each pay its share of covered health care costs.
| AREA OF COMPARISON | MEDICARE ADVANTAGE | MEDICARE SUPPLEMENT INSURANCE |
|---|---|---|
| Coverage | Covers all services under Medicare Parts A & B, and may offer additional benefits. | Covers specific out-of-pocket costs not covered by Medicare, such as deductibles, coinsurance and copays. |
| Cost | Offers lower, or sometimes no monthly premiums. | Features consistent monthly premiums although these are often more expensive. |
| Provider Network | Enrollees are limited to a provider network for coverage, with no coverage outside the U.S. | Enrollees may see any provider who accepts Medicare. |
| Prescription Drug Coverage | Most Medicare Advantage plans include prescription drug coverage. | Does not cover Prescription Drug Plans; must enroll in Medicare Part D. |
Decision support
Determining whether Medicare Advantage is right for you will depend on what services you need based on your health and health-care needs, as well as your budget. It’s always important to evaluate the specifics of all your needs. If you’re not sure which coverage option is right for your needs, a licensed SmartMatch insurance agent can help you confidently make the right decision.
Common questions
You may be eligible for a Medicare Advantage Plan if you:
People under age 65 may also be eligible if they are entitled to Medicare due to a disability, End-Stage Renal Disease (ESRD), amyotrophic lateral sclerosis (ALS), or another qualifying condition.
If you have employer coverage, you may still be eligible to enroll in Medicare Advantage if you meet the qualifications for Medicare coverage. It’s important to review your employer coverage to ensure you’re making the right decision for your budget and coverage needs
Medicare Advantage plans are offered by private insurance companies under contract with the Federal government, therefore, they vary in cost, coverage, copays, and deductibles. Some Medicare Advantage plans provide affordable or $0 premiums, with a variety of coverages and benefits not included in Original Medicare.
Note that even with a $0 premium Medicare Advantage plan, you’ll still pay a monthly premium for Part B, and a Part D premium if your Medicare Advantage plan does not include prescription drug coverage (MA-PD).
People who have Medicare and also receive assistance from Medicaid are commonly described as “dual eligible.” Some dual-eligible individuals may qualify for a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed for people who have both Medicare and Medicaid.
Eligibility, benefits, and cost-sharing assistance vary by state and plan. Medicare generally pays first for Medicare-covered services, while Medicaid may help with Medicare premiums and cost sharing and may cover additional services, depending on your eligibility.
Yes, during certain enrollment periods. During the Medicare Annual Enrollment Period (Oct. 15–Dec. 7), you may leave a Medicare Advantage plan and return to Original Medicare, with the change generally effective Jan. 1.
During the Medicare Advantage Open Enrollment Period (Jan. 1–Mar. 31), people already enrolled in Medicare Advantage may switch to a different Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you may also enroll in a standalone Part D plan. You may make only one plan change during this period. A Special Enrollment Period may also be available after certain life events.
Yes, but timing and eligibility rules apply. You must first leave Medicare Advantage and return to Original Medicare during a valid enrollment period. You may then apply for Medicare Supplement Insurance (Medigap). Outside your Medigap Open Enrollment Period or a guaranteed-issue right, an insurer may use medical underwriting, and availability and pricing can vary by state and carrier.
No, you must choose between the two. Medicare Advantage plans pay for features and benefits, such as vision and dental and/or fitness programs, beyond those available through Medicare Parts A and B. Medicare Supplement Insurance plans help cover out-of-pocket expenses, like coinsurance, copayments, and deductibles.
*There may not be a plan in your area that has these benefits in one plan
Yes. You generally must continue paying your Medicare Part B premium in addition to any Medicare Advantage plan premium. The standard Part B premium is $202.90 per month in 2026, before any Income-Related Monthly Adjustment Amount (IRMAA). Some Medicare Advantage plans offer a Part B Premium Reduction, but it is not available with all plans and the actual reduction may be lower than the amount shown.
Understanding Medicare Advantage coverage can be an overwhelming process, with a variety of carriers, networks, industry terms, and definitions to understand. Working with a licensed SmartMatch insurance agent can streamline this process. Your agent can help you understand and prioritize your needs, then provide available options for you to compare and use when making a coverage decision based on your needs.
| Year | Total Number of Medicare Advantage Plans* |
|---|---|
| 2016 | 1,920 |
| 2017 | 1,957 |
| 2018 | 2,233 |
| 2019 | 2,669 |
| 2020 | 3,068 |
| 2021 | 3,480 |
| 2022 | 3,770 |
| 2023 | 3,998 |
| 2024 | 3,959 |
| 2025 | 3,719 |
| 2026 | 3,373 |
*This is the total number of Medicare Advantage plans nationwide — this does not imply that number of plans is available in your area.
Practical Medicare guidance to help you compare coverage with confidence.
This is a solicitation for insurance. Not connected with or endorsed by the U.S. government or the federal Medicare program. SmartMatch Insurance Agency and its divisions are licensed to sell insurance products in all 50 states and DC. Callers will be connected with a licensed insurance agent who can enroll you into a Medicare Advantage, Prescription Drug (Part D) and Medicare Supplement insurance plan.
We do not offer every plan available in your area. Currently we represent 29 organizations which offer 3,502 products in your area. Please contact Medicare.gov, 1-800-MEDICARE (24 hours a day/7 days a week), or your local State Health Insurance Program to get information on all of your options. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Not all plans offer all benefits. Benefits may vary by carrier and location. Limitations and exclusions apply. No obligation to enroll. SmartMatch Insurance Agency represents Medicare Advantage HMO, HMO SNP, PPO, PPO SNP, and PDP organizations that have a Medicare contract. Enrollment in any plan depends on contract renewal.
PLEASE NOTE: Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal Disease (ESRD). Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
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