Medicare Advantage Plans: Compare your options in 2026

Choosing Medicare coverage can feel overwhelming, especially with so many Medicare Advantage plans available.

During open enrollment…

It can feel like Medicare Advantage ads are everywhere on TV, radio, YouTube, social media, and even in your mailbox.
With so much information coming at you at once, it is not always clear how these plans work or how they differ from Original Medicare. Sound familiar?

Understanding the basics can help you compare your choices and find coverage that fits your health care and cost preferences.

Medicare Advantage plans explained

Medicare Advantage plans (also called Medicare Part C) are offered by private insurance companies that contract with Medicare.¹

Because they are offered by private insurance companies, Medicare Advantage plans can also include additional benefits and coverage that are not offered by Original Medicare, such as prescription drug coverage.²

This flexibility means there’s a lot to understand when comparing Medicare Advantage options.

If you already know what you’re looking for, you can start shopping now.

If you’re unsure of what kind of Medicare Advantage plan may be right for you, read on for more information.

Medicare Advantage plans & Original Medicare: What’s the difference?

Here’s a quick look at how Medicare Advantage plans compare to Original Medicare so you can understand what each type of coverage includes.³

Premiums

Original Medicare beneficiaries pay a premium for Part B and may also pay a Part A premium if they have not paid Medicare taxes for at least 10 years.

Medicare Advantage plans require you to continue paying your Part A premium (if applicable) and your Part B premium. Some Medicare Advantage plans may also charge an additional monthly premium. Premium amounts vary by plan and location.

Out-of-pocket expenses

Original Medicare beneficiaries pay a deductible and typically 20 percent coinsurance for most Part B services.

Medicare Advantage plans have deductibles, but many use copays instead of coinsurance. Costs for deductibles, copays, or coinsurance vary by plan.

Out-of-pocket limit

Original Medicare does not include an annual out-of-pocket cap, which means there is no limit to how much you could pay for covered services.

All Medicare Advantage plans must include an out-of-pocket limit. Once you reach your plan’s limit for the year, you generally will not pay for covered services for the rest of the year. The specific out-of-pocket limit varies by plan and can change annually.

Choice of physician

Original Medicare generally allows you to visit any doctor or hospital in the United States that accepts Medicare.

Medicare Advantage HMO plans typically require you to use a network of contracted physicians and may require you to choose a Primary Care Physician and get referrals for specialists.

Medicare Advantage PPO plans allow you to see out-of-network providers, but you may pay more.

Medicare Supplement Insurance

Beneficiaries with Original Medicare may choose to purchase a Medigap policy to help with out-of-pocket costs.

Medicare Advantage: You cannot buy Medigap while enrolled in a Medicare Advantage plan.

Prescription drug coverage

Original Medicare beneficiaries must purchase a separate Prescription Drug Plan if they want drug coverage. This is known as Medicare Part D.

Many Medicare Advantage plans include prescription drug coverage. These are called Medicare Advantage Prescription Drug plans. Part D plans have a federally set out-of-pocket limit for 2026 of $2,100, and plan deductibles may vary by plan.⁴

If you enroll in a Medicare Advantage plan without prescription drug coverage, you may not be able to join a separate Prescription Drug Plan without being disenrolled from your Medicare Advantage plan.

Dental, vision & hearing

Original Medicare only covers medically necessary services and does not include routine dental, vision, or hearing benefits.

Some Medicare Advantage plans may include additional benefits such as dental, vision, and hearing. Availability varies by plan and location.

Compare Medicare Advantage & Original Medicare

This table will help you easily identify the main differences between Original Medicare and Medicare Advantage plans:

Medicare Advantage & Original Medicare Comparison
	Original Medicare	Medicare Advantage
Costs	Medicare premiums, deductibles and coinsurance	Medicare premiums, deductibles, copays or coinsurance and potentially an additional premium that is specific to the plan
Services covered	Only medically necessary services to treat a disease or condition	Can cover vision, hearing and dental care in addition to medically necessary procedures
Medicare Supplement Insurance (Medigap)	Can purchase a Medigap policy (certain restrictions may apply)	Cannot purchase a Medigap policy while enrolled in an MA plan
Choice of providers	Visit any physician that accepts Medicare	Most plans require the use of in-network doctors, but a PPO plan may allow for coverage outside of a network at an additional cost
Out-of-pocket limits	No	Yes
Prescription drug coverage	No, but customers may purchase a separate Prescription Drug Plan	Many plans include prescription drug coverage. Plans that do not include coverage usually do not allow customers to purchase a separate Prescription Drug Plan.
Referrals for specialists	No	May need a referral from a Primary Care Physician

Types of Medicare Advantage Plans

There are several types of Medicare Advantage plans. These are usually defined by their provider networks and how care is managed.⁵

HMO (Health Maintenance Organization)

Requires use of a specific network of providers and may require a referral before seeing a specialist.

PPO (Preferred Provider Organization)

Offers lower costs when you use in-network providers but allows visits to out-of-network doctors at higher cost.

PFFS (Private Fee-For-Service)

Works similarly to Original Medicare, but the plan decides payment amounts.

SNP (Special Needs Plans)

Designed for people with certain health conditions, dual eligibility for Medicare and Medicaid, or limited income.

HMOPOS (HMO Point-of-Service)

Functions like an HMO but allows some out-of-network services.

MSA (Medical Savings Account)

Combines a high-deductible health plan with a medical savings account funded by Medicare.

Note: Medicare Advantage plans and availability vary by location.

Enrolling in a Medicare Advantage Plan

To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B. People with end-stage renal disease can enroll in many Medicare Advantage plans depending on availability in their service area.⁶

You can enroll during the following periods:

Initial Enrollment Period

A seven-month window that begins three months before you turn 65, includes your birthday month, and ends three months after the month you turn 65.

Under 65 with a disability

If you are under 65 and receive Social Security or Railroad Retirement Board disability benefits, you may qualify for Medicare after 24 months of benefits.

General Enrollment Period

If you sign up for Part B from January 1 to March 31, you may enroll in a Medicare Advantage plan once your Part B coverage starts.

Changing Your Medicare Advantage Plan

You can make changes to your Medicare Advantage coverage during certain periods each year.

Annual Enrollment Period (October 15 to December 7)

During this time, you can:

Switch from Original Medicare to Medicare Advantage
Switch from Medicare Advantage back to Original Medicare
Change from one Medicare Advantage plan to another
Join, drop, or change a Medicare Prescription Drug Plan

Medicare Advantage Open Enrollment Period (January 1 to March 31)

If you are already enrolled in a Medicare Advantage plan, you can:

Switch to a different Medicare Advantage plan
Leave Medicare Advantage and return to Original Medicare

Special Enrollment Periods

Special Enrollment Periods allow you to make changes to your coverage when certain life events occur, such as:⁷

Moving out of your plan’s service area
Moving back to the United States after living abroad
Moving into or out of a skilled nursing facility or other institution
Losing employer or union health coverage

Medicare Advantage & Original Medicare: Ready to explore your options?

Now you know Medicare Advantage plans differ from Original Medicare in several ways. If you want to look at the plans available in your area, you can:

Compare Medicare Advantage options online
Speak with a licensed health insurance agent at (800) 827-9990
Find a licensed health insurance agent in your area