More than 34 million Americans are currently enrolled in Medicare Advantage — and more than 54% of all eligible Medicare beneficiaries now choose a Medicare Advantage plan over Original Medicare. That’s not a coincidence. It reflects a fundamental shift in how older Americans are thinking about their healthcare coverage.

The appeal is real: healthy beneficiaries can save an average of $1,500 per year, many plans carry a $0 monthly premium beyond what you already pay for Part B, and most include vision, dental, and hearing benefits that Original Medicare simply doesn’t cover. Meanwhile, roughly 10,000 Americans turn 65 every single day — meaning this audience and this decision are never going away.

But Medicare Advantage is not right for everyone, and the wrong plan can cost you dearly. This guide walks through everything you need to know: what the plans actually cost in 2026, which providers lead the market, how enrollment periods work, and — critically — how to avoid the traps that catch thousands of new beneficiaries every year.

All premium and cost-sharing figures in this article reflect 2026 amounts published by the Centers for Medicare & Medicaid Services (CMS). Medicare rules change annually; verify your specific plan details at Medicare.gov before enrolling.

What Is Medicare Advantage?

Medicare Advantage — officially called Medicare Part C — is an alternative way to receive your Medicare benefits. Instead of the federal government paying for your care directly through Original Medicare (Parts A and B), you enroll in a plan offered by a CMS-approved private insurance company. That company receives a fixed monthly payment from Medicare on your behalf and must cover at minimum everything that Original Medicare covers.

In practice, most Medicare Advantage plans go well beyond the minimum. They bundle Part A (hospital), Part B (medical), and usually Part D (prescription drugs) into a single plan — and add extra benefits like dental, vision, hearing, and gym memberships. The trade-off is that your care is generally delivered through a network of doctors, hospitals, and specialists rather than the open access you have with Original Medicare.

Medicare Advantage plans are regulated by CMS, which sets strict rules about what plans can offer, how they can market themselves, and what they must disclose. Every plan is rated annually on a 1–5 star scale, and plans that fall below minimum standards can be terminated. This federal oversight gives Medicare Advantage a degree of consumer protection that private insurance outside of Medicare lacks.

Medicare Advantage vs. Original Medicare: Full Comparison

The single most important decision any Medicare beneficiary makes is whether to stay with Original Medicare or switch to a Medicare Advantage plan. The comparison below reflects 2026 figures as published by CMS.

The most critical line in that table is the out-of-pocket maximum. Original Medicare has no cap — a catastrophic illness or prolonged hospital stay can result in tens of thousands of dollars in exposure. Medicare Advantage plans are required by federal law to cap your in-network liability. In 2026, that federal cap sits at $9,250 for in-network services; many plans set their actual cap well below that limit.

That said, Original Medicare’s open-access network is irreplaceable for people who see multiple specialists, travel frequently, or live in multiple states seasonally. No Medicare Advantage plan can match the geographic flexibility of Original Medicare plus a Medigap supplement.

Medicare Advantage Plan Types: HMO, PPO, SNP, and More

Not all Medicare Advantage plans work the same way. The plan type determines how your care is organized, how flexible your doctor choices are, and what you’ll pay when you use services. Understanding these structures is essential before you compare specific plans.

HMO (Health Maintenance Organization)

HMO plans are the most common Medicare Advantage structure and typically offer the lowest premiums and copays. You must select a primary care physician (PCP) who coordinates your care and provides referrals to specialists. All care must come from in-network providers except in genuine emergencies. If you see an out-of-network specialist without a referral, you will likely pay the full cost yourself. HMOs work best for beneficiaries who have a trusted primary care doctor within the plan’s network and prefer lower costs over flexibility.

PPO (Preferred Provider Organization)

PPO plans give you more flexibility: you can see any Medicare-participating provider, in-network or out-of-network, without a referral — though you’ll pay significantly more for out-of-network care. No PCP requirement. PPOs typically carry higher premiums than HMOs but are popular with beneficiaries who have established relationships with specialists they don’t want to give up. They’re also a better fit for people who split time between two locations.

SNP (Special Needs Plan)

Special Needs Plans are designed for specific populations: people with certain chronic conditions (C-SNP), people dually eligible for Medicare and Medicaid (D-SNP), or people living in an institution such as a nursing home (I-SNP). SNPs tailor their benefits, provider networks, and drug formularies to their target population. If you qualify for a D-SNP, for example, you may be able to get comprehensive coverage with very little out-of-pocket cost.

HMO-POS (Point of Service)

A hybrid model that adds limited out-of-network coverage to an HMO structure. You have a PCP and network requirements, but you retain the option to go out of network for certain services — at higher cost. Useful for people who want primarily HMO economics but occasional flexibility.

PFFS (Private Fee-for-Service)

PFFS plans set their own payment terms and allow you to see any provider who agrees to accept those terms. These plans have become rare — fewer than 1% of Medicare Advantage enrollees are in PFFS plans today — as most providers now prefer contracts with HMO and PPO structures.

MSA (Medical Savings Account)

Medicare MSA plans function similarly to a health savings account (HSA) for working-age adults. The plan deposits money into a savings account you can use for healthcare expenses, combined with a high-deductible insurance plan that covers catastrophic costs. These are relatively rare and best suited to beneficiaries in good health who want to build a medical reserve while keeping catastrophic coverage in place.

Top Medicare Advantage Providers in 2026

The Medicare Advantage market is dominated by a handful of large insurers, but regional plans — especially those run by integrated health systems — often deliver higher quality ratings. The table below summarizes the major national players, their estimated 2026 market share, average star ratings, and typical premium ranges. Note: Star ratings are updated annually by CMS; the figures below reflect 2026 contract-year data. Always verify a specific plan’s rating at Medicare Plan Finder.

2026 Market Note: The Medicare Advantage landscape shifted significantly entering 2026. UnitedHealthcare shed roughly 930,000 members as it retrenched from unprofitable markets, while Humana — which maintained benefit generosity — gained over 1 million members and is on track to rival UnitedHealthcare as the largest MA carrier. CVS/Aetna, Elevance, and Centene also trimmed enrollment. Cigna exited the Medicare Advantage market entirely: it sold its MA, Part D, and supplemental benefits business to Health Care Service Corporation (HCSC) in March 2025, and those plans were rebranded as HealthSpring by July 2025. If you were enrolled in a Cigna Medicare Advantage plan, verify your current plan name and insurer.

A few important caveats. First, national star ratings mask enormous variation at the plan level. A large insurer with a 4.0 national average may have individual plans rated 2.5 or 5.0 in your specific county. Second, network quality matters more than brand recognition. A less-recognized regional insurer with a 4.5-star plan and strong local hospital relationships may serve you better than a nationally known name with a thin network in your area. Always search by your zip code, not by brand name. Third, county availability has shrunk: both UnitedHealthcare and Humana exited roughly 200 counties each for 2026, meaning some beneficiaries have fewer choices than before — another reason to check Medicare Plan Finder rather than assuming your preferred insurer still operates in your area.

If you’re self-employed or manage your own healthcare budget alongside other coverage decisions, you may also want to review our guide on best health insurance plans for self-employed workers for broader context on how Medicare fits into your overall financial planning.

Medicare Star Ratings Explained

CMS assigns every Medicare Advantage and Part D plan an annual star rating on a scale of 1 to 5, updated each fall for the following contract year. Ratings are based on dozens of quality measures: how well plans manage chronic conditions, member experience surveys, customer service responsiveness, and health outcomes data. The star rating system is the most objective tool available for comparing plan quality.

• 5 Stars — Excellent. Rare. Only about 6% of Medicare Advantage plans earn a 5-star rating in any given year. These plans represent the top tier of quality and member satisfaction. A unique and significant benefit: 5-star plans allow year-round enrollment, bypassing the usual Annual Enrollment Period restriction. If you find yourself in a poorly rated plan mid-year, switching to a 5-star plan is one of your few options outside of AEP.
• 4 Stars — Above Average. This should be your minimum target when comparing plans. A 4-star plan indicates strong clinical quality and good member experience. Most of the major national insurers aim to maintain their flagship plans at or above 4 stars.
• 3 Stars — Average. Not necessarily a bad plan, but it means something is underperforming — whether that’s customer service, care coordination, or health outcomes. Dig into the individual measure scores to understand what’s dragging the rating down.
• Below 3 Stars — Below Average. CMS may flag consistently low-rated plans for remediation or termination. Beneficiaries in plans rated below 3 stars for three consecutive years may receive a Special Enrollment Period to switch plans. Avoid these plans if alternatives are available in your area.

Star ratings are published each October for the following year. Because they are re-evaluated annually, a plan’s rating can improve or decline year over year. Never assume last year’s rating applies today — always verify the current rating at Medicare.gov Plan Finder before enrolling or re-enrolling.

Annual Enrollment Period (AEP) and Critical Dates for 2026–2027

Medicare has strict enrollment windows. Missing a deadline doesn’t just mean waiting — it can result in late enrollment penalties or gaps in coverage that follow you for years. Know these dates cold.

The AEP is the busiest — and most predatory — time of year in the Medicare market. Insurers spend heavily on advertising during this window, and unethical marketing practices spike. Treat every unsolicited call, mailer, and television ad with appropriate skepticism. Make your own decisions using the Medicare Plan Finder tool and, if helpful, a licensed Medicare broker who is legally required to show you all available options rather than just those of one company.

Extra Benefits That Medicare Advantage Plans Often Include

One of the most compelling reasons seniors choose Medicare Advantage is the extra benefits that Original Medicare simply doesn’t cover. These benefits vary significantly by plan, insurer, and geographic market — not every plan offers every benefit, and the generosity of each benefit can change year to year. Always confirm specific benefits in the plan’s Annual Notice of Change (ANOC) before counting on them.

• Vision Coverage. Most MA plans include at least an annual eye exam and an allowance for glasses or contact lenses ($100–$300 is common). Some plans include coverage for corrective lenses after cataract surgery.
• Dental Coverage. Preventive dental (cleanings, X-rays) is widely included. Comprehensive dental (fillings, extractions, crowns, dentures) is available in higher-tier plans and is becoming more common — though coverage limits vary widely. Understand exactly what the annual dental maximum covers before relying on this benefit.
• Hearing Aids. Many plans include an annual hearing exam and a benefit toward hearing aids, which cost $1,000–$4,000+ per device and are not covered by Original Medicare.
• SilverSneakers and Fitness Memberships. A popular benefit that provides access to participating gyms, fitness centers, and exercise classes at no extra cost. Ask specifically which fitness facilities in your area participate before enrolling based on this benefit.
• Over-the-Counter (OTC) Allowance. Many plans provide a quarterly or annual allowance — typically $25–$150 per quarter — to purchase eligible health products like vitamins, bandages, and over-the-counter medications. Delivered via prepaid card or a catalog ordering system.
• Telehealth. Video and phone visits with providers, often at $0 or very low copay. Widely expanded since 2020 and now a standard feature of most plans.
• Transportation to Medical Appointments. Some plans cover non-emergency medical transportation — rides to doctor’s appointments, pharmacies, or dialysis centers. Availability and number of covered trips varies significantly by plan.
• Meal Delivery After Hospitalization. A growing number of plans offer a limited number of post-discharge meal deliveries to help newly discharged patients recover safely at home and reduce readmissions.
• Caregiver Support and Home Safety Modifications. Some plans, particularly chronic condition SNPs, offer home modification benefits (grab bars, ramps) or caregiver support services.
• Pet Care Benefits. A small but growing number of plans include modest pet care allowances — typically $100–$300 annually — recognizing the documented health benefits of pet ownership for seniors. Rare, but worth noting if it matters to you.

Extra benefits are genuinely valuable, but they should not be the primary basis for choosing a plan. A plan with generous dental coverage but a weak hospital network or a low star rating is a bad trade. Lead with network adequacy and out-of-pocket costs; treat extra benefits as a tiebreaker.

For broader planning around aging and healthcare costs, consider pairing Medicare Advantage research with our overview of long-term care insurance — a complementary product that covers nursing home, assisted living, and home care costs that Medicare Advantage doesn’t touch.

Hidden Costs of Medicare Advantage You Should Know

Medicare Advantage plans are marketed heavily during AEP, often with emphasis on $0 premiums, free extras, and simplicity. The honest picture is more nuanced. Here are the costs and limitations that don’t always make it into the brochures.

• Out-of-Network Specialist Costs. In HMO plans especially, seeing a specialist outside the network — even if that specialist accepts Original Medicare — may result in you paying the full cost. This is the most common and most expensive surprise beneficiaries encounter, typically when they’re already ill and least equipped to navigate it. Always confirm that your key specialists are in-network before enrolling, not after.
• Prior Authorization Requirements. Unlike Original Medicare, which generally pays for any medically necessary service with minimal pre-approval, many Medicare Advantage plans require prior authorization for hospitalizations, certain procedures, specialist visits, and high-cost medications. Delays or denials can be challenged, but the process takes time you may not have during an acute illness. CMS has implemented new rules to tighten authorization timelines, but the requirement itself remains a structural difference.
• Annual Benefit Changes. Every Medicare Advantage plan can — and often does — change its premium, copays, drug formulary, network of providers, and extra benefits at the start of each plan year. Your 2026 plan is not guaranteed to look the same in 2027. This is why reviewing your Annual Notice of Change (ANOC), mailed each September, is not optional — it’s essential.
• Out-of-Area Travel Limitations. Emergency care is covered anywhere in the U.S. under all Medicare Advantage plans. But urgent care (a sick visit that isn’t life-threatening) may not be covered if you’re outside your plan’s service area. This is a meaningful problem for seniors who winter in Florida or Arizona while enrolled in a plan based in another state. PPO plans handle this better than HMOs, but neither replicates the nationwide coverage of Original Medicare.
• Provider Network Changes Mid-Year. Hospitals and physician groups can leave a plan’s network mid-contract year. If your primary care doctor or preferred specialist leaves the network, you may face disruption in care or higher costs for the rest of the year. CMS has strengthened continuity-of-care protections, but the risk is real.
• Copay Stacking on Complex Cases. While the annual out-of-pocket maximum caps your total exposure, reaching that maximum on a complex hospitalization or multi-specialty treatment can still mean thousands of dollars in copays — paid in a short window. The $9,250 federal cap is a ceiling, not a small number.

Who Should NOT Choose Medicare Advantage

Medicare Advantage is genuinely excellent for many beneficiaries — but it is not the right choice for everyone. Be honest with yourself about the following situations.

• Frequent Travelers. If you travel extensively within the U.S. or spend significant time in multiple states, Original Medicare’s nationwide coverage is almost always the better choice. Emergency coverage transfers across the country; routine and urgent care often does not under Medicare Advantage plans.
• People with Complex, Chronic Conditions. Beneficiaries managing multiple serious conditions — cancer, advanced heart disease, end-stage renal disease, ALS — often need frequent access to high-cost specialists, infusion centers, and major academic medical centers. If those institutions are not in a Medicare Advantage network, or if prior authorization creates friction, the plan’s financial savings can be dwarfed by access problems.
• Snowbirds with Dual Residences. If you split your year between two states, most HMO-based Medicare Advantage plans will leave you without in-network coverage at one of your residences. A PPO helps, but the cleanest solution for true snowbirds is Original Medicare plus a Medigap supplement — which follows you everywhere.
• People with Established Specialist Relationships. If you have a rheumatologist, neurologist, or other specialist you’ve worked with for years, and that doctor does not participate in any Medicare Advantage plan in your area, leaving Original Medicare means leaving your doctor. This is a trade-off many people underestimate until they’re facing it.
• Those Who Value Simplicity Over Savings. Original Medicare plus a Medigap supplement is administratively simpler in terms of claims and provider access. If the complexity of managing an HMO — referrals, network verification, formulary checks — feels burdensome, that friction is a real quality-of-life consideration.

Understanding the Medicare landscape also connects to broader retirement financial planning. If you’re thinking about retirement income sources alongside healthcare costs, our guide to Solo 401(k) plans for self-employed workers addresses the retirement savings side of the equation, and our overview of disability insurance covers income protection for those not yet at Medicare age.

How to Compare Medicare Advantage Plans: A Step-by-Step Process

The Medicare Plan Finder at Medicare.gov is the official, unbiased tool for comparing plans in your area. No sign-up required. Use it as your primary research instrument, not as a secondary check after talking to a sales representative.

1. Gather your current doctor list first. Write down the full names and practice names of every physician you see — primary care, specialists, therapists. You’ll use this list to verify network participation for each plan you consider.
2. List your current medications. Note the name, dosage, and frequency of every prescription drug you take. Drug formularies vary significantly between plans, and a drug that’s covered under your current plan may be on a different tier — or not covered at all — under a new plan.
3. Enter your zip code in Medicare Plan Finder. The tool will show every Medicare Advantage plan available in your county along with premium, copay, star rating, and drug coverage information.
4. Filter by your doctors. Use the Plan Finder’s doctor search to confirm whether each plan includes your physicians. Do this for every plan you’re seriously considering — do not trust verbal assurances from sales representatives.
5. Check the drug formulary for each plan. Run your full medication list through each plan’s drug coverage tool. Note the tier each drug falls under and calculate your estimated annual drug cost under each plan. A $0-premium plan can become expensive quickly if your medications land on Tier 3 or Tier 4.
6. Compare the star rating. Set a floor of 4 stars unless there are compelling reasons to consider a lower-rated plan (geographic availability limitations, for example). Use individual measure scores, not just the overall rating, to understand what a 3.5-star plan is underperforming on.
7. Look at the maximum out-of-pocket limit. This is your worst-case annual exposure. A plan with a higher premium but a lower out-of-pocket cap may save you more money if you use significant healthcare services. A lower premium with a higher cap is a better deal only if you’re confident your utilization will stay low.
8. Verify the hospital network. Confirm that your preferred hospital — and any major academic medical center you might need — participates in the plan. Hospital network adequacy is as important as physician network adequacy.
9. Read the Summary of Benefits. Every plan must publish a standardized Summary of Benefits. Read the copay structure for the services you actually use: primary care visits, specialist visits, lab work, imaging, and any procedures you expect in the coming year.
10. Consider a licensed Medicare broker. A broker who represents multiple insurance companies is legally required to show you all plans available in your area and is compensated by insurers, not by you. Avoid captive agents who represent only one insurer. The State Health Insurance Assistance Program (SHIP) also provides free, unbiased counseling at shiphelp.org.

Common AEP Mistakes That Cost Beneficiaries Money

The Annual Enrollment Period is a high-pressure, high-confusion time. Insurers spend billions on marketing, and the decisions made in this 54-day window can affect your healthcare and finances for the entire following year. Avoid these mistakes.

• Switching based solely on a $0 premium. A $0 plan premium is appealing, but it tells you almost nothing about total cost. A plan with a $0 premium and high copays for your specific conditions may cost you far more than a plan with a $50 monthly premium and lower cost-sharing. Calculate expected annual out-of-pocket cost, not just the premium.
• Not verifying your doctors are still in-network. Provider networks change every year. A physician who was in-network in 2026 may not be contracted for 2027. If you’re staying with the same plan, confirm your key doctors are still participating before assuming you’re covered.
• Ignoring formulary changes. Plans send an Annual Notice of Change (ANOC) by September 30 each year. This document lists every change to benefits, cost-sharing, and drug coverage. Most people don’t read it. Read it. A drug moving from Tier 2 to Tier 3 can increase your annual drug cost by hundreds of dollars.
• Enrolling under sales pressure. CMS strictly regulates Medicare Advantage marketing. No sales representative can pressure you to enroll on the spot, offer gifts or payments in exchange for enrollment, or make claims that go beyond the plan’s official benefits. If you feel pressured, end the conversation and report the behavior to 1-800-MEDICARE.
• Missing the December 7 deadline. The AEP closes at midnight on December 7. Enrollment changes you make during AEP take effect January 1. If you miss the deadline, your next opportunity — absent a Special Enrollment Period trigger — is the Medicare Advantage Open Enrollment Period (January 1–March 31), which is more limited in what you can do.
• Assuming last year’s plan is still optimal. Even if you’re happy with your current plan, review your options each AEP. 2026 was an unusually turbulent year — UnitedHealthcare, Humana, Aetna, Elevance, and Centene all reduced their county footprints, and Cigna exited the MA market entirely (its plans are now operated by HCSC under the HealthSpring brand). Hundreds of thousands of beneficiaries were involuntarily displaced from their plans. Always confirm your plan still operates in your area and that your key benefits, doctors, and drugs are unchanged.

Red Flags in Medicare Advantage Sales Pitches

CMS strictly regulates how Medicare Advantage plans can market themselves. The rules exist because Medicare beneficiaries — often older adults on fixed incomes — are frequent targets of deceptive sales practices. Know what’s illegal so you can recognize it when it happens.

• Unsolicited home visits. Medicare marketing rules prohibit agents from visiting your home without a prior appointment that you scheduled. An agent who shows up at your door claiming to discuss “your Medicare benefits” is violating federal regulations.
• Pressure to enroll the same day. Any agent who insists you must decide immediately — “this offer expires today” — is engaging in prohibited pressure tactics. You have the entire AEP to make your decision. Walk away.
• Promises beyond official plan benefits. If an agent verbally promises something that isn’t written in the plan’s Summary of Benefits — “this plan covers dental implants” when the official document says only preventive dental — the verbal promise is meaningless. Only what’s documented in the official plan materials is binding.
• Unsolicited requests for your Medicare number. Your Medicare ID number (formerly your Social Security Number) is sensitive personal information. No legitimate agent needs it from you during an initial sales conversation. Sharing it with an untrustworthy party can expose you to Medicare fraud.
• “Free” gifts in exchange for enrollment. It is illegal for Medicare Advantage plans or their agents to offer gifts, payments, or items of value — beyond items worth less than $15 — as inducements for enrollment. A free gift card, free steak dinner enrollment event, or cash payment in exchange for signing up is a federal violation.
• Claims that a plan is “endorsed by Medicare” or “government-sponsored.” Private Medicare Advantage plans are regulated by the federal government but are sold by private insurers. No plan is “endorsed” or “selected” by Medicare specifically for you.

Report suspected Medicare fraud or marketing violations to 1-800-MEDICARE (1-800-633-4227) or the HHS Office of Inspector General at oig.hhs.gov.

Frequently Asked Questions About Medicare Advantage Plans

What is Medicare Advantage and how is it different from Original Medicare?

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies approved by CMS. It bundles Part A (hospital), Part B (medical), and usually Part D (drugs) into one plan, often with additional benefits like dental, vision, and hearing. The key difference is that Medicare Advantage uses networks and caps your annual out-of-pocket spending, while Original Medicare has open nationwide access but no out-of-pocket maximum.

Do I still pay the Part B premium if I have Medicare Advantage?

Yes. Most Medicare Advantage enrollees continue to pay the standard Part B premium — $202.90 per month in 2026 — in addition to any plan-specific premium. Some plans offer a “premium rebate” that partially offsets the Part B premium, but you are not freed from the Part B premium entirely.

What is the out-of-pocket maximum for Medicare Advantage in 2026?

The federal cap on in-network out-of-pocket spending for Medicare Advantage plans in 2026 is $9,250. Many plans set their actual limit below this ceiling. Some plans also set a separate (higher) cap for combined in-network and out-of-network spending. Original Medicare has no out-of-pocket maximum.

Can I switch Medicare Advantage plans at any time?

Generally no. The main window for switching is the Annual Enrollment Period (October 15 – December 7). You can make one additional switch during the Medicare Advantage Open Enrollment Period (January 1 – March 31). Enrollees in 5-star plans can switch to another 5-star plan year-round. Special Enrollment Periods allow mid-year changes in specific circumstances such as moving, losing other coverage, or qualifying for Medicaid.

What is a Medicare Star Rating and why does it matter?

CMS evaluates every Medicare Advantage plan on dozens of quality measures annually and assigns a rating of 1–5 stars. Higher-rated plans generally have better clinical outcomes, member experiences, and customer service. A minimum of 4 stars is a reasonable target. Critically, 5-star plans allow year-round enrollment — a valuable option if you need to escape a poorly performing plan mid-year.

What extra benefits do Medicare Advantage plans offer?

Common extras include vision (eye exams, glasses), dental (preventive and sometimes comprehensive), hearing aids, gym memberships (SilverSneakers), over-the-counter allowances ($25–$150 per quarter), telehealth, transportation to appointments, and post-hospital meal delivery. Benefits vary by plan and market and can change year to year.

Is Medicare Advantage the same as Medigap?

No. Medigap (Medicare Supplement Insurance) is a private policy that works alongside Original Medicare to fill coverage gaps — paying deductibles, coinsurance, and copays that Original Medicare doesn’t fully cover. Medigap cannot be combined with Medicare Advantage. You choose one path or the other: Medicare Advantage replaces Original Medicare, while Medigap supplements it.

What is the Annual Enrollment Period (AEP)?

The AEP runs from October 15 to December 7 each year. During this window, Medicare beneficiaries can enroll in a Medicare Advantage plan for the first time, switch from one Medicare Advantage plan to another, drop Medicare Advantage and return to Original Medicare, or change their Part D prescription drug plan. Changes made during AEP take effect January 1 of the following year.

What is a Special Needs Plan (SNP)?

SNPs are Medicare Advantage plans specifically designed for people with certain chronic conditions (C-SNP), people who qualify for both Medicare and Medicaid (D-SNP), or people who live in institutions like nursing homes (I-SNP). SNPs tailor their benefits, networks, and drug formularies to their target population and may offer significantly better coverage and lower costs for eligible individuals.

Can I use my Medicare Advantage plan when I travel?

Emergency care is covered nationwide under all Medicare Advantage plans. Urgent (non-emergency) care outside your plan’s service area may or may not be covered depending on whether you have an HMO or PPO plan. Routine care is generally limited to your plan’s geographic area. Frequent travelers or seasonal residents in multiple states should carefully evaluate whether Medicare Advantage meets their needs or whether Original Medicare is a better fit.

What happens if my doctor leaves my Medicare Advantage plan’s network?

CMS provides some continuity-of-care protections — typically allowing you to complete a course of treatment with a departing provider — but coverage is not guaranteed long-term. If a key provider leaves mid-year, you generally must wait until AEP to switch plans unless you qualify for a Special Enrollment Period. This is why verifying network participation at enrollment, not just annually, is important.

Do Medicare Advantage plans cover prescription drugs?

Most Medicare Advantage plans — called MA-PD or MAPD plans — include Part D prescription drug coverage. A small number of plans do not include drug coverage, in which case you’d need a separate Part D plan if you want drug coverage. Always verify whether the plan you’re considering includes Part D and check whether your specific medications are covered on that plan’s formulary.

What is prior authorization in Medicare Advantage?

Prior authorization (PA) is a requirement that your doctor obtain approval from the plan before certain services, procedures, or medications are covered. Original Medicare uses prior authorization sparingly; Medicare Advantage plans use it more broadly. CMS has implemented new rules to standardize PA timelines, but it remains a meaningful difference from Original Medicare for people who need frequent or complex care.

Can I go back to Original Medicare after being on Medicare Advantage?

Yes. During AEP (October 15 – December 7) or the MA OEP (January 1 – March 31), you can disenroll from Medicare Advantage and return to Original Medicare. Be aware that if you return to Original Medicare after age 65, Medigap insurers in most states are not required to sell you a policy without medical underwriting — meaning you could be denied or charged higher premiums for a supplement plan based on health status. Research Medigap availability before leaving Medicare Advantage.

How do I find Medicare Advantage plans near me?

Use the official Medicare Plan Finder at Medicare.gov. Enter your zip code to see every Medicare Advantage plan available in your county, compare premiums, star ratings, drug coverage, and extra benefits, and verify whether your specific doctors and medications are covered. The tool is free, unbiased, and requires no personal information to start browsing.

What Medicare Advantage plan is best for me?

There is no single best plan. The right plan depends on your health status, the medications you take, the doctors and hospitals you prefer, your budget, how much you travel, and whether you have chronic conditions. Use Medicare.gov Plan Finder as your research tool, verify your doctors and drugs are covered, prioritize plans rated 4 stars or higher, and consider consulting a licensed Medicare broker or a free SHIP counselor at shiphelp.org for personalized guidance.