Plans
Medicare Advantage (Part C)
Quick answer
Medicare Advantage, also called Part C, is a way to receive your Medicare benefits through a private insurance plan approved by Medicare. Plans bundle Part A and Part B, usually include Part D drug coverage, and often add dental, vision, and hearing.
Plain-English definition
When you enroll, Medicare pays the plan a set amount each month to manage your care. You still have Medicare — the plan just administers it under its own network, formulary, and rules.
Why it matters
Medicare Advantage caps your annual out-of-pocket spending (MOOP) and can bundle extras Original Medicare doesn't cover.
A simple example
You enroll in a $0-premium HMO with a $4,000 MOOP, $10 primary-care copays, and included dental.
Common mistakes & misconceptions
- Assuming every provider takes every plan — networks vary by county.
- Overlooking prior-authorization rules on imaging, therapy, or surgery.
Child topics
Related terms
Medicare Part B
Medicare Part B is the medical insurance half of Original Medicare. It covers doctor visits, outpatient care, preventive screenings, mental health services, and durable medical equipment.
Medicare Part D
Medicare Part D is prescription drug coverage sold by private insurance companies approved by Medicare. You get it either as a stand-alone drug plan (PDP) with Original Medicare or bundled inside most Medicare Advantage plans.
MOOP (Maximum Out-of-Pocket)
MOOP stands for Maximum Out-of-Pocket. It's the yearly cap on what you pay for covered in-network medical services in a Medicare Advantage plan. Once you hit it, the plan pays 100% of covered Part A and Part B care for the rest of the calendar year.
Formulary
A formulary is the official list of prescription drugs a Medicare Part D or Medicare Advantage plan covers, organized by tier. Every plan has its own formulary, and the same drug can be a different tier from one plan to another.
IRMAA (Income-Related Monthly Adjustment Amount)
IRMAA is an income-based surcharge added to Medicare Part B and Part D premiums for higher earners. Social Security calculates it from your IRS tax return two years prior.
HMO
A Medicare Advantage HMO is a plan that uses a specific network of doctors and hospitals. You choose a primary care provider (PCP) and usually need a referral to see specialists.
PPO
A Medicare Advantage PPO lets you see providers in or out of the network, usually without a referral. Out-of-network care costs more and has its own MOOP.
Frequently asked questions
Do I still have Medicare with a Medicare Advantage plan?+
Yes. You keep Medicare and continue paying the Part B premium; the plan simply administers your benefits.
Can I switch back to Original Medicare?+
Yes, during the AEP (Oct 15 – Dec 7) or the Medicare Advantage OEP (Jan 1 – Mar 31).
People also ask
Is Medicare Advantage better than Medigap?
Neither is universally better — MA plans have lower premiums and built-in extras but use networks; Medigap costs more but offers broad access.
Sources & references
📚 Where this information comes from
When you're ready, compare plans on your own terms
See Medicare Advantage plans from the insurance companies we represent, or walk the course with a licensed agent whenever you'd like a second set of eyes.
We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.
Medicare Caddies is an independent insurance agency. We are not affiliated with, endorsed by, or connected to the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services (CMS). We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.