What is Medicare Advantage?
Medicare Advantage plans are some of the most talked about kinds of plans in the world of Medicare. Between the nonstop television commercials promising free stuff, to the endless pieces of mail that rain down on Medicare beneficiaries boasting $0 premium insurance plans, (Not all plans offer all these benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays and coinsurance may apply.)vthey certainly have become popular, but also very controversial.
The way that Medicare Advantage plans can easily be defined would be all-in-one comprehensive plans that provide a person on Medicare medical coverage, prescription coverage, as well as additional benefits that could include dental, vision, and hearing benefits, as well.
The person purchasing this plan essentially has their Medicare ran through a private insurance company, to which the private insurance company comes in and takes over the risk of covering that individual.
How Much Does Medicare Advantage Cost?
Medicare pays the private insurer a fixed amount every month to cover you, and that funding is why many Medicare Advantage plans charge no additional premium. You still pay your Part B premium ($202.90 a month in 2026, more with IRMAA), and the plan charges copays or coinsurance when you use care: a primary care visit, a specialist, a hospital stay, an MRI. Every plan sets a yearly maximum out-of-pocket for medical costs, and plans with drug coverage follow the 2026 Part D rules (deductible up to $615, drug costs capped at $2,100).
The right comparison is total yearly cost, not the premium: your expected visits and prescriptions against each plan’s copays, network and maximum. That is the comparison we run for you at no charge. (Not all plans offer all benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays and coinsurance may apply.)
That is where all the $0 premium talk comes from. The person that enrolls into a Medicare Advantage plan must still keep their Medicare Parts A & B active in order for their Advantage plan to work (that includes paying their Medicare Part-B premium). Usually the commercials leave that part out! (Not all plans offer all these benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays and coinsurance may apply.)
So...What's The Catch?
While Medicare Advantage plans do have a lot be excited about, they do have some important downsides that people need to be aware of. Unlike original Medicare with a supplemental plan, you do not have the freedom to go to any doctor in America that accepts Medicare assignment when you are on a Medicare Advantage plan. You are typically assigned a network of hospitals and doctors and either get decreased benefits when going outside of this network, or none at all.
Medicare Advantage plans also can come with more restrictions, such as referral programs and prior authorizations on certain treatments and/or procedures. Characteristically, they have a larger portion out of pocket expense because Advantage plans typically charge copays for most services provided. Copays can add up! The two most common network types for Medicare Advantage plans are the HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Here is a short video we made explaining the difference of the two!
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