Medicare Advantage — also known as Medicare Part C — is the fastest-growing form of health insurance in the United States. More than 33 million Americans are enrolled in Medicare Advantage plans in 2026, representing more than half of all Medicare beneficiaries for the first time in the program’s history. If you are turning 65, newly eligible for Medicare, or reviewing your existing coverage during Open Enrollment, understanding Medicare Advantage plans is essential to making the right choice for your health and your finances.
Medicare Advantage plans are offered by private insurance companies approved by the federal government and must cover everything that Original Medicare covers — but they often deliver these benefits at lower out-of-pocket cost, bundle in prescription drug coverage, and include extra benefits like dental, vision, hearing, gym memberships, and over-the-counter allowances that Original Medicare does not provide.
This comprehensive guide covers everything you need to know about Medicare Advantage plans in 2026: what they cover, what they cost, the different plan types, the major insurers offering them, the extra benefits available, how they compare to Original Medicare, how to enroll, and the official government resources that every Medicare beneficiary should know.
What Is Medicare Advantage (Part C)?
Medicare Advantage is an alternative way to receive your Medicare benefits. Instead of receiving coverage directly from the federal government through Original Medicare (Parts A and B), you enroll in a private insurance plan that has been approved and contracted by the Centers for Medicare and Medicaid Services (CMS) to deliver your Medicare benefits.
How Medicare Advantage Works
• You still pay your Medicare Part B premium — the standard Part B premium in 2026 is $185.00 per month. Medicare Advantage plans are required by law to collect at least the Part B premium.
• Many plans charge an additional plan premium — this ranges from $0 per month (for $0 premium plans) to $100 or more per month depending on the plan and your geographic area.
• The government pays the private insurer a fixed monthly amount per enrollee — in exchange, the plan takes responsibility for covering your Medicare-covered services and any additional benefits the plan offers.
• You use the plan’s network of doctors and hospitals — unlike Original Medicare which is accepted nearly everywhere, Medicare Advantage plans have defined provider networks. Using in-network providers results in lower cost-sharing.
• Most plans include Part D prescription drug coverage — called Medicare Advantage Prescription Drug plans (MAPD), these plans bundle hospital, medical, and drug coverage in a single plan.
• Plans must cover all Original Medicare benefits — CMS requires Medicare Advantage plans to cover everything Original Medicare covers with some flexibility in how cost-sharing is structured.
Medicare Advantage vs Original Medicare: Key Differences
• Original Medicare — no network restrictions, accepted by virtually all US hospitals and physicians who accept Medicare. No out-of-pocket maximum. Does not include prescription drugs. No dental, vision, or hearing coverage. Medicare pays directly.
• Medicare Advantage — network restrictions apply (HMO, PPO, PFFS models). Annual out-of-pocket maximum required by law (no more than $9,350 for in-network in 2026). Usually includes prescription drug coverage. Often includes dental, vision, hearing, and other extra benefits. Private insurer pays providers on Medicare’s behalf.
Medicare Advantage Plan Types in 2026
Medicare Advantage plans come in several different structural types, each with different rules about networks, referrals, and costs. Understanding these types is the first step to choosing the right plan.
HMO – Health Maintenance Organization
HMO plans are the most common type of Medicare Advantage plan. They have the most restrictive network rules but typically offer the lowest premiums and cost-sharing.
• You must use doctors, hospitals, and other providers in the plan’s network for covered services, except in true medical emergencies.
• You generally need a referral from your primary care physician to see a specialist.
• Out-of-network care is not covered except in genuine emergencies.
• Typically offer the lowest monthly premiums and cost-sharing among Medicare Advantage plan types.
• HMO-POS (Point of Service) variation — some HMO plans allow out-of-network care at higher cost-sharing through a point-of-service option.
• Best for — beneficiaries who are comfortable with a primary care physician gatekeeper model, have all their preferred providers in-network, and want the lowest possible premiums and copays.
PPO – Preferred Provider Organization
PPO plans offer more flexibility than HMOs. You can see any Medicare-accepting doctor or hospital, in-network or out-of-network, without a referral — but you pay more for out-of-network care.
• No referral required to see specialists — you can see any specialist directly without going through a primary care physician.
• In-network care costs less — using in-network providers results in lower copays and coinsurance.
• Out-of-network care is covered but costs more — you pay higher cost-sharing for out-of-network providers, but coverage is not denied.
• Generally higher premiums than HMO plans — the added flexibility comes at a higher monthly cost.
• Best for — beneficiaries who want flexibility to see specialists without referrals, travel frequently, or have specialists outside the HMO network they want to keep seeing.
PFFS – Private Fee-for-Service
PFFS plans establish their own payment terms for providers. Any provider who agrees to the plan’s terms can treat you as an in-network provider.
• No established network — any provider who accepts the plan’s terms can provide care.
• Providers must agree to the plan’s payment terms for each visit — not all providers will accept PFFS plans.
• More flexibility than HMO but less predictable than PPO in terms of provider acceptance.
• Less common than HMO and PPO plans and declining in enrollment.
SNP – Special Needs Plans
Special Needs Plans are Medicare Advantage plans specifically designed for people with particular health conditions, dual Medicare-Medicaid eligibility, or institutional living arrangements.
• Dual Eligible SNP (D-SNP) — for people who qualify for both Medicare and Medicaid. These plans coordinate benefits between both programs and often have very low or no cost-sharing.
• Chronic Condition SNP (C-SNP) — for people with specific serious chronic conditions such as diabetes, heart disease, end-stage renal disease, HIV/AIDS, or chronic heart failure. Plans are specifically designed to manage these conditions with targeted benefits and care coordination.
• Institutional SNP (I-SNP) — for people who live in or are expected to live in a skilled nursing facility, nursing home, or other institution for 90 or more days.
• Best for — people who qualify for Medicaid in addition to Medicare, or who have serious chronic conditions that would benefit from a plan specifically designed around managing those conditions.
MSA – Medicare Medical Savings Account
MSA plans combine a high-deductible Medicare Advantage plan with a medical savings account that Medicare funds each year to help pay for healthcare costs.
• High deductible — you pay all costs out of pocket until you meet a high annual deductible.
• Medicare deposits money into your MSA account — you can use these funds tax-free for qualified medical expenses.
• No prescription drug coverage — you must enroll in a separate Part D plan.
• No network restrictions — you can see any Medicare-accepting provider.
• Best for — healthy beneficiaries who use little healthcare and want to accumulate tax-free savings.
What Medicare Advantage Plans Cover in 2026
Required Coverage: Everything Original Medicare Covers
By federal law, all Medicare Advantage plans must cover everything that Original Medicare Parts A and B cover:
• Inpatient hospital care — hospital room and board, nursing care, medications administered during hospitalization, surgical procedures, and other inpatient services
• Outpatient medical services — physician visits, outpatient surgery, emergency room visits, preventive care, lab tests, and imaging
• Skilled nursing facility care — following a qualifying hospital stay of at least 3 days, up to 100 days of skilled nursing care
• Home health services — part-time skilled nursing, physical therapy, occupational therapy, and speech therapy in the home
• Hospice care — Medicare Advantage plans must allow enrollees to elect hospice under Original Medicare Part A rather than through the plan
• Durable medical equipment — wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and other medically necessary equipment
• Preventive services — all ACA-required preventive services at no cost-sharing including annual wellness visits, cancer screenings, flu shots, and recommended vaccines
• Mental health services — inpatient and outpatient mental health treatment at parity with medical benefits
• Substance use disorder treatment — detoxification, residential treatment, and outpatient programs
• Emergency care — emergency room and urgently needed care covered anywhere in the US at in-network cost-sharing rates
Extra Benefits Medicare Advantage Plans May Offer
One of the most significant advantages of Medicare Advantage over Original Medicare is the ability for plans to offer extra benefits beyond what Medicare requires. In 2026, the following extra benefits are available in many Medicare Advantage plans:
• Dental coverage — preventive dental care (cleanings, X-rays, exams) is offered in the vast majority of Medicare Advantage plans. Comprehensive dental (fillings, extractions, crowns, dentures, implants) varies significantly by plan. Original Medicare does not cover routine dental care.
• Vision coverage — most Medicare Advantage plans cover routine eye exams and provide an annual allowance for prescription eyeglasses or contact lenses. Original Medicare does not cover routine vision care.
• Hearing benefits — most Medicare Advantage plans cover routine hearing exams and provide an annual allowance for hearing aids. Original Medicare does not cover routine hearing exams or hearing aids.
• Prescription drug coverage (Part D) — most Medicare Advantage plans include Part D prescription drug coverage bundled in a single plan (MAPD). This eliminates the need to purchase a separate Part D plan.
• Over-the-counter (OTC) allowance — many Medicare Advantage plans provide a quarterly or annual allowance ($25 to $150 or more per quarter) for over-the-counter health products including vitamins, pain relievers, bandages, and other health items. Available through participating retailers or mail order.
• Fitness and gym memberships (SilverSneakers, Silver and Fit) — most Medicare Advantage plans include free membership to participating fitness centers, gyms, and online fitness programs.
• Transportation assistance — many plans provide a set number of free or subsidized rides per year to medical appointments, pharmacies, and fitness centers.
• Meal delivery after hospitalization — some plans provide home-delivered meals following a hospital stay or surgery during the recovery period.
• Home safety modifications — some plans provide allowances for home safety modifications such as grab bars, ramp installation, or non-slip flooring to reduce fall risk.
• Telehealth services — virtually all Medicare Advantage plans now cover telehealth visits with physicians and specialists via video, often with $0 copay.
• Caregiver support services — some plans offer respite care, caregiver education, and support services for family members caring for enrollees.
• Insulin affordability — under the Inflation Reduction Act, Medicare Advantage plans cap covered insulin cost-sharing at $35 per month per insulin product.
Medicare Advantage Costs in 2026
Understanding the cost structure of Medicare Advantage plans helps you accurately compare total out-of-pocket costs across different plan options. Medicare Advantage plans have multiple cost components.
Monthly Premiums
• Part B premium — you continue to pay the Medicare Part B premium of $185.00 per month in 2026 regardless of which Medicare Advantage plan you choose. Higher-income beneficiaries pay an Income-Related Monthly Adjustment Amount (IRMAA) surcharge on top of the standard Part B premium.
• Plan premium — the additional monthly premium charged by the Medicare Advantage plan itself. In 2026, the average Medicare Advantage plan premium is approximately $18 per month. Many $0 premium plans are available in most counties. Some plans with richer benefits charge $50 to $150 or more per month.
• Part D premium (if included) — if prescription drug coverage is bundled in your Medicare Advantage plan (MAPD), the Part D premium is typically included in the plan premium.
• IRMAA surcharge for high earners — beneficiaries with 2024 income above $106,000 (individual) or $212,000 (married filing jointly) pay additional monthly surcharges for both Part B and Part D.
Deductibles
• Medical deductible — many Medicare Advantage plans have a $0 medical deductible for most services. Some plans have deductibles of $100 to $500 per year for certain services.
• Part D drug deductible — the maximum Part D deductible in 2026 is $590 per year. Many Medicare Advantage plans with drug coverage offer a $0 drug deductible, particularly for generic medications.
• Inpatient hospital deductible — instead of Medicare’s standard $1,740 Part A deductible per benefit period, Medicare Advantage plans typically charge a fixed copay per day of hospital admission (often $0 to $400 per day for the first several days).
Copays and Coinsurance
• Primary care physician visits — typically $0 to $15 copay per visit for in-network PCPs. Many plans offer $0 preventive care visits.
• Specialist visits — typically $30 to $55 copay per in-network specialist visit.
• Emergency room visits — typically $90 to $120 copay per visit (waived if admitted to the hospital).
• Urgent care visits — typically $40 to $65 copay per visit.
• Inpatient hospital stays — typically $0 to $400 per day for days 1 through 5 or 7, then $0 per day after that. Some plans charge a flat copay per admission.
• Outpatient surgery — typically 10% to 20% coinsurance or a fixed copay per procedure.
• Diagnostic lab tests — typically $0 copay for routine lab work at in-network labs.
• Imaging (X-ray, CT, MRI) — typically $50 to $350 per study depending on complexity and plan.
Out-of-Pocket Maximum – Your Most Important Financial Protection
The out-of-pocket maximum is one of the most valuable features of Medicare Advantage compared to Original Medicare. Original Medicare has no out-of-pocket cap, meaning your costs can be unlimited in a catastrophic year. Medicare Advantage plans are required by law to cap your annual out-of-pocket spending.
• 2026 maximum in-network out-of-pocket limit — $9,350 for in-network services (set by CMS). Once you reach this limit, the plan pays 100% of covered in-network services for the rest of the calendar year.
• 2026 maximum combined in-and-out-of-network limit — $14,000 for plans that cover out-of-network care (PPO plans). Applies to combined in-network and out-of-network cost-sharing.
• Most plans set their actual out-of-pocket maximum well below the CMS maximum — competitive plans commonly set out-of-pocket maximums of $3,000 to $6,000 for in-network services.
• Drug costs excluded — the out-of-pocket maximum applies to medical benefits. Part D drug costs have a separate $2,000 out-of-pocket cap in 2026 under the Inflation Reduction Act.
Part D Drug Cost Cap – Major 2026 Change
The Inflation Reduction Act created a landmark $2,000 annual out-of-pocket cap on Medicare Part D prescription drug costs, effective January 1, 2025 and continuing in 2026. This is one of the most significant changes to Medicare in decades:
• $2,000 annual out-of-pocket cap — once you spend $2,000 out of pocket on covered Part D drugs in a calendar year, you pay $0 for all covered drugs for the rest of the year regardless of the drug’s list price.
• Insulin capped at $35 per month — each covered insulin product is capped at $35 per month with no deductible.
• Vaccine cost eliminated — all vaccines recommended by ACIP are covered at $0 cost-sharing under Part D.
• Medicare Prescription Payment Plan — beneficiaries can spread their out-of-pocket drug costs across the calendar year in monthly installments rather than paying large amounts early in the year.
Top Medicare Advantage Insurance Companies in 2026
Medicare Advantage plans are offered by private insurance companies that have been approved and contracted by CMS. Here are the major insurers offering Medicare Advantage plans nationally in 2026:
UnitedHealthcare
UnitedHealthcare is the largest Medicare Advantage insurer in the United States with approximately 9.5 million Medicare Advantage enrollees in 2026. It offers plans in virtually every county in the US under the AARP Medicare Advantage brand (in partnership with AARP) and the UnitedHealthcare Medicare Advantage brand.
• Plan types available — HMO, PPO, HMO-POS, D-SNP, C-SNP, and MSA plans
• Strengths — extremely broad availability, large provider networks in most markets, strong AARP brand recognition, SilverSneakers fitness benefit, robust telehealth through UnitedHealth’s virtual care platform
• Renew Active fitness program — free gym membership plus online fitness classes and brain health activities
• Average star rating — 3.5 to 4.0 stars nationally (CMS star ratings vary by specific plan and market)
• Find UnitedHealthcare plans at — uhcmedicaresolutions.com or medicare.gov plan finder
Humana
Humana is the second-largest Medicare Advantage insurer with approximately 6.3 million enrollees in 2026. It is particularly strong in the southern United States and offers a wide range of plan types.
• Plan types available — HMO, PPO, PFFS, D-SNP, C-SNP plans
• Strengths — strong presence in the South and Southeast, competitive $0 premium plans in many markets, SilverSneakers fitness benefit, well-regarded Go365 wellness program
• Go365 wellness program — rewards program earning points for healthy behaviors redeemable for gift cards and other rewards
• Average star rating — 3.5 to 4.0 stars nationally
• Find Humana plans at — humana.com/medicare or medicare.gov plan finder
CVS Health / Aetna
CVS Health’s Aetna Medicare is the third-largest Medicare Advantage insurer with approximately 4.5 million enrollees. CVS’s acquisition of Aetna created unique advantages including integration with CVS pharmacy networks.
• Plan types available — HMO, PPO, D-SNP, C-SNP plans
• Strengths — CVS pharmacy integration with potential $0 copays at CVS pharmacies, strong plan design in many markets, SilverSneakers fitness benefit, extensive CVS MinuteClinic network for no-cost primary care visits
• CVS pharmacy advantage — Aetna Medicare plans often offer $0 copays at CVS/pharmacy for generic drugs and CVS MinuteClinic visits
• Average star rating — 3.5 to 4.5 stars nationally
• Find Aetna Medicare plans at — aetnamedicare.com or medicare.gov plan finder
Elevance Health (Anthem Blue Cross)
Elevance Health, the parent company of Anthem Blue Cross Blue Shield, offers Medicare Advantage plans under the Anthem and Blue Cross Blue Shield names in many states.
• Plan types available — HMO, PPO, D-SNP plans
• Strengths — Blue Cross Blue Shield brand recognition and large provider networks, strong plan quality in many markets
• Average star rating — 3.5 to 4.0 stars nationally
• Find Anthem Medicare plans at — anthem.com/medicare or medicare.gov plan finder
Cigna-Healthspring
Cigna’s Medicare Advantage plans are offered through Cigna-Healthspring and are available in many markets nationally.
• Plan types available — HMO, PPO, D-SNP plans
• Strengths — competitive plan designs in served markets, SilverSneakers fitness benefit, strong prescription drug coverage
• Find Cigna Medicare plans at — cigna.com/medicare
Kaiser Permanente
Kaiser Permanente offers Medicare Advantage plans exclusively in the markets where Kaiser operates its integrated health system: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington state, and Washington DC.
• Plan type — HMO exclusively (Kaiser’s integrated model)
• Strengths — fully integrated care where Medicare Advantage plan, hospitals, physicians, and pharmacy are all part of the same organization. Consistently among the highest CMS star ratings nationally, often 4.5 to 5 stars.
• Limitation — only available in Kaiser service areas. Not suitable for patients who travel frequently or spend significant time outside the Kaiser service area.
• Find Kaiser Medicare plans at — kp.org/medicare
SCAN Health Plan
SCAN Health Plan is a not-for-profit Medicare Advantage plan primarily serving California, Nevada, Arizona, Texas, and Colorado. It is consistently among the highest-rated Medicare Advantage plans nationally.
• Average star rating — consistently 4.5 to 5 stars from CMS, among the highest ratings of any Medicare Advantage plan nationally
• Strengths — exceptional quality ratings, member services, and care coordination. Not-for-profit structure focused on member benefit rather than profit.
• Find SCAN plans at — scanhealthplan.com
CMS Star Ratings for Medicare Advantage Plans 2026
The Centers for Medicare and Medicaid Services (CMS) rates all Medicare Advantage plans on a 1 to 5 star scale based on quality and performance measures. These star ratings are one of the most useful tools for comparing plans:
What CMS Star Ratings Measure
• Staying healthy: screenings, tests, and vaccines — how well the plan gets members the preventive care they need
• Managing chronic long-term conditions — how well the plan manages conditions like diabetes, heart disease, and COPD
• Member experience with the health plan — member satisfaction, how easy it is to get care, and communication with providers
• Member complaints and changes in the health plan’s performance — the number of complaints filed with Medicare and whether plan performance is improving or declining
• Health plan customer service — responsiveness, accuracy, and helpfulness of the plan’s member services
• Drug plan customer service — how well the plan manages prescription drug benefits
How to Use Star Ratings When Choosing a Plan
• 5-star plans — the highest quality Medicare Advantage plans. CMS allows special enrollment in 5-star plans at any time during the year (not limited to Open Enrollment). Seek 5-star or 4.5-star plans in your area.
• 4-star or higher — indicates above-average quality. Beneficiaries in 4-star or higher plans receive bonus benefits and better care coordination.
• 3 stars or below — plans rated below 3 stars for 3 consecutive years face sanctions from CMS including potential contract termination. A low star rating is a meaningful quality warning sign.
• Find CMS star ratings for all plans at — medicare.gov/plan-compare. Star ratings are updated annually each October for the following plan year.
Medicare Advantage Enrollment: When and How to Enroll in 2026
When You Can Enroll in a Medicare Advantage Plan
• Initial Enrollment Period (IEP) — the 7-month window around your 65th birthday (3 months before, the month of, and 3 months after your 65th birthday). This is your first opportunity to enroll in Medicare Advantage.
• Annual Open Enrollment Period (OEP) — October 15 to December 7 each year. During this period you can switch between Medicare Advantage plans, switch from Original Medicare to Medicare Advantage, switch from Medicare Advantage to Original Medicare, or join, switch, or drop a Part D prescription drug plan. Changes take effect January 1.
• Medicare Advantage Open Enrollment Period — January 1 to March 31 each year. If you are already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare during this period. Changes take effect the first of the following month.
• Special Enrollment Periods (SEPs) — triggered by specific life events: moving to a new service area, losing other coverage, qualifying for Medicaid, entering or leaving a nursing home, or the plan’s contract with Medicare ending.
• 5-star plan enrollment — you can enroll in a Medicare Advantage plan with a 5-star CMS rating at any time of year (once per year).
How to Enroll in a Medicare Advantage Plan
1. Research plans available in your zip code using the Medicare Plan Finder at medicare.gov/plan-compare. Enter your zip code, medications, and preferred doctors to compare plans available in your area.
2. Compare plans on premium, out-of-pocket maximum, drug coverage, doctor and hospital networks, and extra benefits using the Plan Finder comparison tool.
3. Verify that your doctors and preferred hospitals are in the plan’s network. Call each provider directly to confirm they are currently accepting the specific plan, not just the insurer.
4. Verify that your medications are covered on the plan’s formulary (drug list) and at what cost tier. Use the plan finder’s drug cost estimate tool to calculate your expected annual drug costs under each plan.
5. Contact the plan directly or call 1-800-MEDICARE (1-800-633-4227) to enroll. You can also enroll online at medicare.gov, through the plan’s website, or by calling the plan’s member services number.
6. Consider consulting a licensed Medicare insurance broker or an independent Medicare counselor through your State Health Insurance Assistance Program (SHIP). SHIP counselors provide free, unbiased Medicare enrollment assistance in every state.
How to Compare Medicare Advantage Plans: Step-by-Step
Choosing the right Medicare Advantage plan requires systematically comparing the options available in your specific zip code. The same plan can have very different networks and costs in different counties.
Step 1: List Your Priorities
• Your current doctors — identify your primary care physician and all specialists you see regularly. Your plan must include them in-network.
• Your current medications — list every prescription drug you take including the specific drug name, dosage, and how often you take it. Your plan’s drug formulary must cover your medications at an acceptable cost.
• Your preferred hospitals — identify which hospitals you would want to use for planned procedures and emergencies. Verify they are in-network.
• Your health needs and anticipated care — if you have chronic conditions requiring frequent specialist visits, prioritize low specialist copays and out-of-pocket maximum. If you are generally healthy, a lower-premium plan with higher cost-sharing may be appropriate.
• Extra benefits importance — determine which extra benefits matter most to you: dental, vision, hearing, OTC allowance, fitness membership, transportation.
Step 2: Use Medicare Plan Finder at medicare.gov/plan-compare
• Enter your zip code and enrollment information.
• Enter all your prescription drugs with dosages and quantity to calculate accurate drug cost estimates.
• Enter your doctors to check network inclusion.
• Compare plans side by side on all cost and benefit dimensions.
• Review each plan’s star rating and member experience scores.
Step 3: Verify Network Before Enrolling
• Call each of your doctors directly — ask specifically: Do you currently accept [Plan Name] from [Insurer Name]? Are you accepting new patients on this plan?
• Call the hospital directly — verify that your preferred hospital is currently in the plan’s network as a participating facility.
• Do not rely solely on the insurer’s online provider directory — directories are frequently outdated. Direct phone verification is the only reliable method.
Step 4: Calculate Your True Total Annual Cost
• Add up: Annual plan premium x 12 months
• Add: Part B premium x 12 months ($185 x 12 = $2,220 in 2026)
• Estimate: Expected medical costs based on your typical annual healthcare utilization multiplied by your copays and coinsurance
• Estimate: Expected annual drug costs using the Plan Finder’s drug cost calculator
• Compare: Total estimated annual cost across your top plan choices, not just monthly premiums
Medicare Advantage and Supplemental (Medigap) Coverage
An important rule to understand: you cannot have both a Medicare Advantage plan and a Medigap (Medicare Supplement) policy at the same time. These are mutually exclusive options:
• Medicare Advantage replaces Original Medicare — when you join Medicare Advantage, your coverage comes from the private plan rather than directly from Medicare. Medigap policies only supplement Original Medicare and have no value when you are in Medicare Advantage.
• Original Medicare plus Medigap — an alternative approach where you keep Original Medicare (Parts A and B) and purchase a separate Medigap policy to fill the gaps (deductibles, coinsurance, copays) plus a separate Part D plan for drug coverage.
• Medigap Plan G — the most comprehensive Medigap plan available to new enrollees in 2026. Covers the Part A deductible, Part A coinsurance, and Part B 20% coinsurance, resulting in near-zero out-of-pocket for most hospital and medical care.
• Which is better — Medicare Advantage vs Original Medicare plus Medigap: Medicare Advantage often has lower monthly premiums and extra benefits but network restrictions and variable cost-sharing. Original Medicare plus Medigap has higher monthly costs (premiums for both Part B and Medigap) but maximum flexibility (any Medicare-accepting provider) and more predictable out-of-pocket costs. The right choice depends on your health, finances, preferred providers, and how much you value network flexibility.
Medicare Advantage for People with Chronic Conditions
If you have chronic health conditions, Medicare Advantage — particularly Chronic Condition Special Needs Plans (C-SNPs) — may offer significant advantages over Original Medicare through targeted care coordination and condition-specific benefits.
Medicare Advantage Benefits for Common Chronic Conditions
• Diabetes — C-SNPs for diabetes offer $0 insulin copays, continuous glucose monitor coverage, diabetes education programs, dietitian services, and care coordination. All Medicare Advantage plans cap insulin at $35 per month per covered insulin under the Inflation Reduction Act.
• Heart disease and heart failure — C-SNPs for heart disease offer cardiac rehabilitation coverage, remote cardiac monitoring, care coordination between cardiologists and primary care, and targeted disease management programs. Standard Medicare Advantage plans also cover cardiac rehabilitation following qualifying cardiac events.
• Chronic kidney disease and end-stage renal disease (ESRD) — ESRD C-SNPs for dialysis patients offer transportation to dialysis, care coordination between nephrologists and dialysis centers, and integrated drug coverage for transplant medications.
• Mental health conditions — C-SNPs for mental health offer integrated behavioral health and medical care coordination, telehealth behavioral health visits, and medication management programs.
• COPD and respiratory disease — care management programs, smoking cessation support, respiratory therapy, and home oxygen equipment coverage.
• Cancer — while no cancer-specific C-SNPs exist, many Medicare Advantage plans offer care coordination for cancer patients, transportation to treatments, and $0 copays for chemotherapy at infusion centers.
What Medicare Advantage Does NOT Cover
Understanding coverage limitations helps you avoid surprise costs and plan for expenses Medicare Advantage will not cover:
• Long-term custodial care — Medicare Advantage, like Original Medicare, does not cover custodial care in nursing homes (help with daily activities like bathing and dressing). This requires Medicaid, long-term care insurance, or private payment.
• Dental care beyond plan allowances — while most plans include some dental, comprehensive dental coverage (implants, major restorative work) is often limited. Dental allowances may not cover all needed procedures.
• Out-of-network care in HMO plans — HMO plans do not cover non-emergency care from out-of-network providers. Receiving care outside the network results in no coverage and full patient responsibility.
• Care received outside the US — Medicare Advantage does not cover care received outside the United States except in very limited circumstances (emergency care near the border with Canada or Mexico in some cases). Travel medical insurance is recommended for international travel.
• Cosmetic procedures — procedures deemed cosmetic rather than medically necessary are not covered.
• Experimental treatments — treatments labeled experimental or investigational by the plan are generally not covered, though clinical trial routine care costs are covered under federal law.
How to Get Help Choosing a Medicare Advantage Plan for Free
State Health Insurance Assistance Program (SHIP)
SHIP is a federally funded program providing free, unbiased, one-on-one Medicare counseling in every state. SHIP counselors are not insurance agents and do not earn commissions. They help you understand all Medicare options, compare plans, and enroll in the right coverage for your situation.
• Free to all Medicare beneficiaries and their families.
• Find your local SHIP program at shiphelp.org or by calling 1-800-MEDICARE.
• Services available — comparing Medicare Advantage and Original Medicare options, reviewing drug coverage, understanding your rights, assistance with enrollment, and help with Medicare billing problems.
1-800-MEDICARE (1-800-633-4227)
The official Medicare helpline operates 24 hours a day, 7 days a week. Representatives can answer questions about Medicare Advantage plans, help you compare options, and assist with enrollment.
Medicare Plan Finder at medicare.gov/plan-compare
The official Medicare Plan Finder allows you to compare all Medicare Advantage plans available in your zip code side by side, enter your medications and doctors to find plans covering them, see estimated annual costs, and view CMS star ratings for each plan.
Official US Government Medicare Resources
• Medicare.gov – Official Medicare Website — https://www.medicare.gov
• Medicare Plan Finder – Compare Medicare Advantage Plans in Your Area — https://www.medicare.gov/plan-compare
• CMS Medicare Advantage Information — https://www.cms.gov/medicare/health-plans/medicareadvtgspecneeds
• Medicare.gov – What Medicare Advantage Covers — https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
• Medicare Part D Drug Coverage and $2,000 Cap Information — https://www.medicare.gov/drug-coverage-part-d
• Medicare Enrollment Periods — https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan
• SHIP – State Health Insurance Assistance Program — https://www.shiphelp.org
• 1-800-MEDICARE – Official Medicare Helpline — https://www.medicare.gov/talk-to-someone
• CMS Medicare Star Ratings — https://www.cms.gov/medicare/quality/part-c-d-performance-data
• Medicare Rights Center – Free Counseling — https://www.medicareinteractive.org
• Benefits.gov – Federal Benefits Finder — https://www.benefits.gov
• Social Security Administration – Medicare Enrollment — https://www.ssa.gov/medicare
• Medicare.gov – Medigap vs Medicare Advantage Comparison — https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
• NIH MedlinePlus – Medicare Information — https://medlineplus.gov/medicare.html
• Medicaid.gov – Dual Eligible (Medicare and Medicaid) — https://www.medicaid.gov/medicaid/eligibility/medicaid-and-chip-eligibility/medicaid-and-medicare/index.html
Frequently Asked Questions
What is the difference between Medicare Advantage and Original Medicare?
Original Medicare is the federal government program covering inpatient care (Part A) and medical services (Part B) with no network restrictions and no out-of-pocket maximum. Medicare Advantage is an alternative delivered by private insurers that must cover everything Original Medicare covers but adds network restrictions, an annual out-of-pocket maximum, and often extra benefits like dental, vision, hearing, and prescription drugs. More than half of Medicare beneficiaries are now enrolled in Medicare Advantage plans in 2026.
Is Medicare Advantage better than Original Medicare in 2026?
Whether Medicare Advantage is better depends on your individual circumstances. Medicare Advantage is often the better choice if you want lower monthly premiums, an annual cap on out-of-pocket spending, bundled prescription drug coverage, and extra benefits like dental, vision, and hearing care, and your preferred doctors are in the plan’s network. Original Medicare is often the better choice if you want the freedom to see any Medicare-accepting provider anywhere in the US without network restrictions, plan to travel frequently, or have a Medigap policy covering your cost-sharing gaps. There is no universally correct answer — the best choice depends on your health needs, finances, and preferences.
Can I switch from Medicare Advantage back to Original Medicare?
Yes. You can switch from Medicare Advantage back to Original Medicare during the Annual Open Enrollment Period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). When switching back to Original Medicare, be aware that you may not be able to purchase a Medigap policy without medical underwriting if you are outside your initial Medigap enrollment period, unless you live in a state with additional Medigap protections.
What is the Medicare Advantage out-of-pocket maximum in 2026?
CMS sets the maximum allowable out-of-pocket limit for Medicare Advantage plans at $9,350 for in-network services and $14,000 for combined in-network and out-of-network services in 2026. However, most competitive Medicare Advantage plans set their actual out-of-pocket maximums well below these CMS caps, typically in the range of $3,000 to $6,000 for in-network care. Once you reach the out-of-pocket maximum, the plan pays 100% of covered in-network services for the remainder of the calendar year. Prescription drug costs have a separate $2,000 annual out-of-pocket cap under the Inflation Reduction Act.
Do Medicare Advantage plans cover dental care?
Most Medicare Advantage plans in 2026 include some dental coverage, which Original Medicare does not provide. Preventive dental care — cleanings, exams, and X-rays — is covered in the vast majority of plans. Comprehensive dental care including fillings, extractions, crowns, and dentures is available in many plans but coverage limits vary significantly. Some plans offer annual dental allowances of $1,000 to $3,000 or more for comprehensive care. Dental implants are covered by some but not all plans and often have separate coverage limits. Always review the specific dental benefits of any plan you are considering before enrolling.
Can I keep my current doctor with Medicare Advantage?
This depends on whether your doctor is in the plan’s provider network. HMO plans require you to use in-network providers for all covered care (except emergencies). PPO plans allow out-of-network care but at higher cost. Before enrolling in any Medicare Advantage plan, verify directly with each of your doctors by phone whether they currently accept that specific plan and are accepting new patients. Do not rely solely on the insurer’s online provider directory, which may not be current. If keeping your current doctor is your top priority, verify network participation before enrollment.
What happens if I need care when traveling out of my plan’s service area?
All Medicare Advantage plans must cover emergency care and urgently needed care at in-network cost-sharing rates anywhere in the United States, even if you are outside your plan’s service area when the emergency or urgent care need occurs. However, most HMO plans do not cover non-emergency care received outside the service area. PPO plans typically cover out-of-network non-emergency care at higher cost-sharing. If you travel frequently or spend extended time in a different geographic area, choose a PPO plan or verify that the plan has a national network sufficient for your travel patterns. For international travel, Medicare Advantage (like Original Medicare) generally does not cover care outside the US, so travel health insurance is recommended.
⚠️ Disclaimer: This article is for informational and educational purposes only and does not constitute financial, legal, or insurance advice. Medicare Advantage plan availability, premiums, benefits, provider networks, and formularies vary by plan and geographic area and change annually. The information in this article reflects 2026 plan year data and government regulations as of 2026, which may change in future years. Always verify current plan details, network status, and drug coverage directly with the plan before enrolling. Use the official Medicare Plan Finder at medicare.gov/plan-compare and contact your local SHIP counselor for free personalized guidance. Contact 1-800-MEDICARE (1-800-633-4227) with specific Medicare questions.