Medicare Advantage, also called Medicare Part C, can be a great choice for getting more from your Medicare benefits. But it’s not right for everyone. In this article, we’ll explain how Medicare Advantage works—and walk you through the pros and cons of this comprehensive coverage option.

What's the difference between original Medicare (Parts A and B) and Medicare Advantage?

Original Medicare covers basic health care services like hospital stays (Part A) and doctor visits (Part B). It was the first type of Medicare program created by the federal government in 1965. To expand coverage to include prescription drugs, original Medicare can be combined with a Medicare Part D plan. Some people also add a Medigap plan (supplemental coverage) to cover the cost gaps in original Medicare.

Another way to receive your Medicare coverage is through a Medicare Advantage plan. This is a privately managed alternative to original Medicare. A Medicare Advantage plan covers all the services of original Medicare and usually includes Part D coverage as well.

“In most cases, you’ll need to use health care providers who participate in the plan’s network; however, some [Medicare Advantage] plans offer non-emergency coverage out-of-network, but typically at a higher cost,” Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits, told Medical News Today. “These plans may also offer additional extra benefits like vision, dental, or fitness and wellness benefits that are not covered by Medicare.”

What is the benefit of having a Medicare Advantage plan?

There are five key advantages to choosing a Medicare Advantage plan compared to original Medicare only:

1. Lower costs. Although you must pay the Part B premium with both options, Medicare Advantage premiums are often less expensive (sometimes $0) compared to original Medicare combined with a Medigap policy. In addition, Medicare Advantage plans have a maximum out-of-pocket spending limit for each policy period. In 2025, this cap is $9,350 for approved services (but some plans set lower limits). Once the cap is reached, no additional payments are required for covered services for the rest of the year. Original Medicare does not offer an out-of-pocket maximum, so your expenses could be much higher.
2. Similar to employer health insurance. If you're leaving a job where health insurance was offered, a Medicare Advantage plan will look similar. Deductibles, co-insurance, drug coverage, and physician networks (if you have an HMO plan) are all part of the package.
3. One plan instead of several. A Medicare Advantage plan is an “all in one” system. Often, you have only one insurance card to keep track of, not three. Some people prefer to deal with one plan versus the separate plans of original Medicare, Part D, and Medigap.
4. More coordinated care. HMO Medicare Advantage plans require you to have a primary care physician (PCP). They are the “gatekeeper” for all your care, responsible for making sure your team collaborates with other medical professionals on your treatment. For people with complicated health conditions, this kind of coordinated effort can be valuable.
5. Additional benefits (not covered by original Medicare). Medicare Advantage plans often include prescription drug coverage, plus vision, hearing, and dental benefits—all of which are not part of original Medicare. In some cases, an additional premium may be required, but that is not true for all plans.

What are the disadvantages of a Medicare Advantage plan?

There are four key disadvantages of choosing a Medicare Advantage plan versus original Medicare:

1. Getting coverage for procedures can be more complicated. Since managed care plans aim to keep health care costs within budget, they try to prevent overuse through various means—such as “prior authorization” requirements for surgery, home health care, hospital stays, and medical equipment. Doctors often must provide additional proof of necessity for a service before the plan will pay.
2. Billing before you receive treatment. With Medicare Advantage, copayments are paid prior to treatment. For multiple physician visits, there may be several copayments required upfront before you can see a doctor or receive care. In contrast, if you have original Medicare plus Medigap, you would owe a 20% coinsurance (billed after the service) that would be covered by your Medigap policy.
3. Less freedom in choosing health care providers. With Original Medicare, you can see any physician who accepts Medicare, which gives you access to providers and major medical centers nationwide. In contrast, Medicare Advantage plans are more restrictive in terms of provider networks. A network is a list of doctors, hospitals, and/or pharmacies that negotiate prices with insurance companies. In some areas, it can be difficult to find a local doctor or hospital that works with Medicare Advantage. And if you visit a doctor or a hospital that isn’t “in-network,” you will pay higher out-of-pocket costs.
4. Less compatible with other forms of retiree coverage. There are also some limitations in how Medicare Advantage works with other types of retiree coverage. For example, people with TRICARE for Life need to enroll in original Medicare (versus Medicare Advantage) in order to keep their TRICARE coverage. Prior to enrolling in a Medicare Advantage plan, be sure to find out how it will work with other retiree coverage you have.

Switching from Medicare Advantage to original Medicare

Switching between a Medicare Advantage plan and original Medicare is allowed once a year—during the annual Medicare Open Enrollment period from Oct. 15-Dec. 7. During this time, anyone with Medicare Advantage can switch to original Medicare.

In most states, anyone enrolled in a Medicare Advantage plan for more than one year is not likely to be able to enroll in a Medigap policy. If enrollment is possible, there may be additional guidelines to meet. Staying on a Medicare Advantage plan for more than one year—and then trying to switch to original Medicare—may result in limited (or nonexistent) Medigap choices. That's why it's important to take the time to read and discuss these options with a licensed Medicare benefits adviser.

Where's the best place to get advice on Medicare?

The good news is there are several ways to get expert Medicare guidance from people who know the program inside and out. We’ve outlined some options below.

State Health Insurance Assistance Programs (SHIPs)

SHIPs offer free, impartial, and personalized insurance counseling and assistance to Medicare-eligible older adults, their families, and caregivers. They do not sell insurance products of any kind. These programs are available in all 50 states, Puerto Rico, Guam, D.C., and the U.S. Virgin Islands.

A certified SHIP counselor can help you:

• Learn the basics of Medicare, including who is eligible
• Review your options for health and/or prescription drug coverage
• Understand Medicare out-of-pocket costs as well as programs that can help you pay for these costs
• Ensure your rights are protected under Medicare
• Refer you to other agencies for additional help, if needed

These trained volunteers can also help you deal with Medicare billing problems and complaints about medical care or treatment. Find your local SHIP office here or call 1-877-839-2675.

My Care, My Choice

If you live in California, Michigan, and Ohio, My Care, My Choice is an online decision support tool for people who are dual-eligible (eligible for both Medicare and Medicaid). This resource can help you understand your Medicare and Medicaid coverage options and how the two programs work together. Visit the website and click on your state to get started.

Medicare Support Hotline

Available 24/7, Medicare's 1-800-MEDICARE (1-800-633-4227) Support Hotline can help you with your Medicare questions and concerns. You can also visit the Medicare.gov website to start a live chat. TTY users should call 1-877-486-2048.