2025 Medicare Advantage Plans (Part C): Compare Coverage & Benefits
Learn how Medicare Advantage works, what it covers, and how to choose the best plan for your needs
What Are Medicare Advantage (Part C) Plans?
In general, there are two options for core Medicare benefits: Original Medicare (often supplemented with a Medicare Supplement plan) or Medicare Advantage. The latter of these options, Medicare Advantage plans, also called Medicare Part C or MA plans, are considered to be all-in-one healthcare coverage.
Offered by private insurance companies, these plans cover all basic services that Part A and B cover (except hospice care, which is still covered by Original Medicare) — but the true value of a Medicare Advantage plan is that it can cover other healthcare costs that Original Medicare may not.
Benefits and all out-of-pocket costs are dictated by the insurance company, including costs for surgeries, basic treatments, and any related services. Some plans may also include dental, vision, and hearing insurance, travel insurance, or wellness programs.
Additionally, most Medicare Advantage plans include prescription drug coverage (typically referred to as MA-PD). If you want prescription drug benefits and a MA-PD plan is available, you should enroll in a MA-PD plan, not an additional Medicare Part D plan, which typically works with Original Medicare.
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Medicare Part C: Medicare Advantage
What Do Medicare Advantage Plans Cover?
Every Medicare Advantage Plan is required to cover all the services that Original Medicare (Part A and Part B) covers, with the exception of hospice care (which is still covered by Original Medicare).
| Part | Benefit |
|---|---|
| Part A (Hospital Insurance) | Inpatient hospital stays, skilled nursing facility care, and some home health services. |
| Part B (Medical Insurance) | Doctor visits (primary care and specialists), outpatient care, preventive services (like screenings and vaccines), lab tests, X-rays, durable medical equipment (DME), and emergency ambulance services. |
Commonly Included Benefits
Since Medicare Advantage Plans are offered by private insurance companies, benefits, costs (such as copays, deductibles, and premiums), and rules can vary from one plan to another. There are some benefits that may be included in plans like routine dental, vision, and/or hearing care, health and wellness programs, and OTC allowances.
Keep in mind: Specific plan benefits and networks can (and usually do) change from year to year. It’s important to review your benefit offerings annually. Additionally, not every plan will be available in your area, and these benefits vary by region and carrier.
Medicare Advantage Plan Types
Medicare Advantage plans offer different networks. These contracted groups of doctors, hospitals, specialists, and other healthcare providers have agreed to work with a private insurance company to provide services to people enrolled in a specific Medicare Advantage Plan.
Each network has pros and cons, and the one you choose will depend on your full budget and anticipated healthcare needs.
Health Maintenance Organization (HMO) vs. Preferred Provider Organization (PPO)
HMOs have a fairly strict network of doctors and hospitals that members are generally required to use. If you want to use a provider outside of the plan network, you may be required to pay the full cost out-of-pocket, unless it is an emergency or urgent care. To see a specialist, you generally will need a referral from your primary care doctor for coverage.
HMO is the most popular plan type; more than half of all Medicare Advantage enrollees are on a HMO plan.
A PPO, on the other hand, usually allows beneficiaries to visit any doctor, hospital, or specialist, but they typically have a network that offers cheaper services. These plans are less restrictive, but often come with higher monthly premiums.
Additional Medicare Advantage Plan Types
While HMOs and PPOs are popular choices, there are a handful of other Medicare Part C network types, including:
- HMO Point of Service (POS): This plan has the benefits of an HMO with more flexibility to see providers outside the network at a higher out-of-pocket cost.
- Special Needs Plans (SNPs): Made for people with special health or financial conditions, the benefits, provider options, and prescription drug coverage are specifically designed to meet the needs of each beneficiary.
- Private Fee-For-Service (PFFS): With this plan type, the insurance company determines how much it pays the provider and how much the beneficiary pays for covered services. Not all Medicare providers accept this plan.
- Medicare Savings Account (MSA): These plans are combined with a bank account for expenses, similar to a traditional health savings account (HSA). These plans are very limited in availability, with most private carriers no longer offering them in 2026.
Recommended Reading
Medicare Part C: Medicare Advantage
Medicare Advantage Costs
Plan premium
Each insurance provider sets monthly premiums that are subject to change from year to year. Not all Medicare Advantage plans have monthly premiums, but for the policies that come with much more comprehensive benefits that cover more care, such as prescriptions, dental, and more, you should expect to pay a higher amount.
Part B premium
With Medicare Part C, you will still be required to pay the standard Part B premium ($206.50 or higher in 2026, depending on your income) in addition to your Advantage plan monthly premium. People who receive Social Security benefits may pay less than that amount.
Copays
Medicare Advantage members also pay copays for medical services such as x-rays, lab work, and ambulance rides, which vary by plan. If these copays add up to more than what you would spend on a Medigap plan, then Original Medicare plus a Medigap plan may be a better option.
Coinsurance
Unlike Original Medicare, Advantage plans are required to have an out-of-pocket limit for beneficiaries. The out-of-pocket maximum that a plan will charge for in-network services varies, but in 2025 the maximum amount set by CMS is $9,350 and $14,000 for in-network and out-of-network services combined. If a plan has higher monthly premiums, but lower out-of-pocket maximum limits, it could save you money overall.
Out-of-network costs
Seeing providers in-network is crucial for managing out-of-pocket costs. If you choose to visit a doctor out of network, you may be responsible for 100% of the cost of care. Your plan’s explanation of benefits and yearly Annual Notice of Change will detail which providers are in-network.
How to Compare Medicare Advantage Plans
Medicare uses a Star Rating System to measure the strength of Medicare Advantage and Part D plans. Ratings range from one to five stars, with five being the best. On Medicare's website, you can use the star ratings to figure out which plan is the highest rated and best fits your needs. United Medicare Advisors does not offer Medicare Advantage plans, but our partner agency SmartMatch does.
Other factors to consider while comparing Medicare Advantage plans include:
- Coverage: What benefits are included?
All Medicare Advantage plans must cover at least the same services as Original Medicare (Part A and Part B), but many include additional coverage. Check for coverage of routine services that Original Medicare does not include, such as vision exams, dental care, hearing aids, and gym memberships.
- Network: Where Can I Go for Care?
Your plan's provider network determines which doctors, hospitals, and specialists you can use, so you’ll need to decide which works for you. Some offer lower costs but strict network limits, while others provide more network flexibility but higher costs.
- Costs: What Will I Pay Out-of-Pocket?
Costs go beyond your monthly premium. Be sure to research each plan’s deductible, copayments/coinsurance, and maximum out-of-pocket limits. Also, factor in the extra benefits (like vision, dental, and wellness programs) that some plans offer.
- Prescriptions: Are My Medications Covered?
Most Medicare Advantage Plans include prescription drug coverage (Part D), but you should make sure your current medications are covered at a reasonable price by checking each plan’s formulary. Additionally, if you have preferences for pharmacies, check that it’s in your plan’s network.
Medicare Advantage Enrollment
To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B. Then, you’re generally able to enroll in a plan as long as you live in the plan’s service area and do not have end-stage renal disease (ESRD). If you do have ESRD, you may be able to enroll in a Special Needs Plan.
There are several timelines during which you can enroll in a Medicare Advantage plan:
- Initial Enrollment Period
When you first begin Medicare, you have an Initial Enrollment Period, during which you can add a Medicare Advantage plan to your health care strategy.
- Annual Open Enrollment Period
During the Annual Open Enrollment period from Oct. 15 through Dec. 7 you may enroll in a new Advantage plan or apply for a Medicare Supplement plan.
- Medicare Advantage Open Enrollment Period
If you’re already enrolled in a Medicare Advantage plan, you can make changes to your plan during this window, from Jan. 1 to March 31.
- Special Enrollment Period
Some people may qualify for a Special Enrollment Period. These typically occur in situations that are out of the beneficiary’s control, such as moving out of the service area or an insurance company going out of business.
Recommended Reading
Read More About Medicare Enrollment
Switching from Medicare Advantage to Original Medicare
If you’re enrolled in Medicare Advantage and want to switch to Original Medicare, you can do so during the Annual Open Enrollment Period or the Medicare Advantage Open Enrollment Period. To make the switch, you can contact our team or your plan provider, or call 1-800-MEDICARE (1-800-633-4227) during these windows.
When you make the change to Original Medicare, you may also want to consider a Medicare Supplement, or Medigap, plan to reduce your healthcare costs.
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Medicare Supplement vs. Medicare Advantage
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