Medicare Part C

Types of Medicare Advantage Plans

Medicare Advantage plans are offered by private companies that must follow the rules set by Medicare. When you join one, you still have Medicare, but your Part A and Part B benefits come through the plan rather than through Original Medicare, and you use the plan’s card for your care.

Not all Medicare Advantage plans work the same way. The plan type determines which doctors you can see, whether you need referrals, and how much you pay when you go out of network, so it is worth understanding the differences before you choose.

The Five Types Part C Plans

Medicare Advantage plans fall into five main types.

HMO

Health Maintenance Organization (HMO) plans use a network of doctors, hospitals, and specialists. You usually choose a primary care doctor who coordinates your care and gives referrals to specialists. Except for emergencies and urgent care, you generally need to stay in network. HMOs often have the lowest premiums and copays. Some are HMO Point-of-Service (HMO-POS) plans, which cover certain out-of-network care at a higher cost.

PPO

Preferred Provider Organization (PPO) plans have a network too, but they also cover care outside it at a higher cost, and you do not need referrals to see specialists. PPOs are a good fit if you want more provider choice or spend time in another state, though premiums and copays tend to be higher than HMOs.

SNP

Special Needs Plans (SNPs) are built for specific groups: people with both Medicare and Medicaid (D-SNPs), people with certain chronic conditions such as diabetes or heart failure (C-SNPs), and people living in a nursing home or needing that level of care at home (I-SNPs). Benefits, networks, and care coordination are tailored to those needs, and SNPs must include drug coverage.

PFFS

Private Fee-for-Service (PFFS) plans let you see any Medicare-approved provider who agrees to the plan’s payment terms. The plan decides how much it pays providers and how much you pay. PFFS plans are less common, and a provider can decide visit by visit whether to accept the plan, so check before each appointment.

MSA

Medical Savings Account (MSA) plans combine a high-deductible plan with a bank account that Medicare deposits money into each year. You use that money to pay for care until you meet the deductible. MSA plans do not include drug coverage, so you would join a separate Part D plan.

Medicare Advantage Enrollment and Eligibility

You can join a Medicare Advantage plan if you have both Medicare Part A and Part B, live in the plan’s service area, and are a U.S. citizen or lawfully present in the U.S. People with End-Stage Renal Disease (ESRD) can also join. If you live in another state for part of the year, ask whether the plan covers you there.

When You Can Enroll

You can first join during your Initial Enrollment Period, the seven months around your 65th birthday. After that, the Medicare Annual Enrollment Period runs from October 15 to December 7, with coverage starting January 1. During the Medicare Advantage Open Enrollment Period, from January 1 to March 31, people already in a Medicare Advantage plan can switch plans or return to Original Medicare one time. Special Enrollment Periods apply after certain events, such as moving or losing other coverage.

How to Enroll

You can enroll through a licensed broker, directly with the insurance company, on Medicare.gov, or by calling 1-800-MEDICARE. Working with an independent broker lets you compare plans from several companies side by side, check your doctors and drugs, and get help later if you need it, at no extra cost to you.

Medicare Advantage Costs

Lower premiums are one of the main reasons people choose Medicare Advantage, and many plans charge no premium beyond what you already pay for Part B. You must keep paying your Part B premium no matter which plan you choose, though some plans include a Part B giveback that reduces it.

Copays and the Out-of-Pocket Maximum

Instead of paying 20% coinsurance like Original Medicare, you pay the copays and coinsurance set by your plan, such as a set amount for a doctor visit or a hospital stay. Every plan has a yearly out-of-pocket maximum for covered services. In 2026, Medicare caps in-network out-of-pocket costs at $9,250, and many plans set their limit lower. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Medicare Advantage vs. Medigap

The main alternative to Medicare Advantage is Original Medicare paired with a Medicare Supplement (Medigap) plan and a Part D plan. Medigap usually costs more each month but leaves you with little or nothing to pay when you get care, and you can see any provider in the country that accepts Medicare, with no networks or referrals.

Medicare Advantage usually costs less each month and often includes extra benefits, but you pay copays as you use care and generally need to stay in the plan’s network. You cannot have both at the same time. If you leave Medicare Advantage later, you may not be able to buy a Medigap plan without answering health questions, so it is worth weighing this choice carefully when you first enroll.

Frequently Asked Questions

Do I still pay my Part B premium with Medicare Advantage?

Yes. You keep paying your Part B premium, plus your plan’s premium if it has one.

Can I keep my doctor?

It depends on the plan’s network. We check that your doctors and hospitals are in network before you enroll.

Does Medicare Advantage include drug coverage?

Most plans do. If a plan does not, you may be able to add a stand-alone Part D plan, depending on the plan type.

Can I switch plans if I’m not happy?

Yes. You can change plans during the Annual Enrollment Period each fall, and people in a Medicare Advantage plan can make one change from January 1 to March 31.