What Is a Medicare Advantage Plan?

Medicare Advantage plans bundle your Medicare coverage into a single plan. Plans are sold by private insurance companies that contract with the federal government.

This all-in-one package is often the cheapest way to get coverage. Most Medicare Advantage plans come with a $0 monthly premium. The trade-off for lower costs upfront is more rules when you use your coverage. Most plans limit you to in-network providers, and many require the plan’s approval before they’ll pay for certain services.

Medicare Advantage plans are required to provide the same benefits as:

• Medicare Part A, which covers hospitalization. 

• Medicare Part B, which covers doctor’s visits. (You’ll still have to pay your Part B premium, which is $202.90 in 2026 for most people.)

Medicare Advantage plans also typically include:

• Medicare Part D prescription drug coverage.

• Extra benefits like some coverage for routine dental care, eye exams and glasses, and hearing aids.

Source: Medicare.gov and KFF

Medicare Advantage plans fall under two main umbrellas: health maintenance organizations (HMOs) and preferred provider organizations (PPOs). About 60% of Medicare Advantage beneficiaries are enrolled in HMOs, while about 40% are in PPOs

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KFF. Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization. Accessed Aug 21, 2026. View all sources .

Special needs plans (SNPs) are designed for people who qualify because of certain chronic conditions, because they have both Medicare and Medicaid, or because they need institutional care. They can be either HMO or PPO plans. Nearly 1 in 4 Medicare Advantage enrollees are in SNPs

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KFF. Medicare Advantage in 2026: Enrollment Update and Key Trends. Accessed Aug 21, 2026. View all sources .

There are two less common types of Medicare Advantage plans: private fee-for-service (PFFS) plans and medical savings account (MSA) plans. PFFS plans set their own payment terms, and you can see any provider who accepts them. MSA plans come with a high deductible and a savings account that Medicare funds.

About 55% of people eligible for Medicare are in Medicare Advantage plans, but popularity doesn’t mean it’s always a good fit.

Pros:

• Extra benefits: Almost all Medicare Advantage enrollees get perks like some hearing, dental and vision coverage. This isn’t included in Original Medicare

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  Centers for Medicare & Medicaid Services. Understanding Medicare Advantage Plans. Accessed Aug 21, 2026. View all sources .

• Lower premiums: Roughly two-thirds of Medicare Advantage plans (67%) have no monthly premiums. Plans with premiums charge an average of about $42 per month, according to NerdWallet’s analysis of Centers for Medicare & Medicaid Services (CMS) data.

• Spending caps: Unlike Original Medicare, Medicare Advantage plans come with a limit on how much you have to pay out of pocket for hospital and medical care each year. This limit is determined by CMS, and it can be as high as $9,250 for in-network care in 2026. However, the average out-of-pocket max is about $6,120 in 2026, according to NerdWallet analysis.

• Drug coverage: Almost all Medicare Advantage enrollees have prescription drug coverage included in their plan.

• All-in-one care: You get your hospital, medical and drug benefits through one insurance company.

Cons:

• Provider choice: With Medicare Advantage, you generally must use providers within your plan's network. And networks can change from year to year, so a doctor who’s in-network this year might not be next year.

• Travel restrictions: You must live in your plan’s service area, and most plans won’t pay for routine care you get outside of it, though emergency care is covered throughout the U.S.

• Less plan flexibility: If you have Medicare Advantage, there are limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance, or Medigap, policy.

• Prior authorization requirements: Nearly all Medicare Advantage plans require approval to have certain tests or procedures, which can delay care.

• Plan restrictions: You may have to get a referral from your primary care physician to see a specialist, unlike Original Medicare.

• Coverage disruptions: Your Medicare Advantage plan could end coverage, or your provider could leave the network in the middle of the year. (If this happens, you’ll be notified and offered other options.)

» TAKE OUR QUIZ: Are Medicare Advantage plans worth it?

Medicare Advantage plan availability varies by location. Click on a state on the map below to see the best Medicare Advantage plans available in that state.

Don’t let flashy advertisements drive your decision. Perks like gym memberships, grocery allowances and money back in your Social Security check are often smaller than they sound. For example, the money back is a rebate on your Medicare Part B premium, and most often these rebates are below $10 per month.

Start with non-negotiables: Make sure any doctors or facilities you want to visit are in network and your prescription drugs are covered at a price you can afford. From there, weigh Medicare Advantage plan costs and premiums.

Here are some questions to ask as you evaluate Medicare Advantage plans:

• Coverage: Are all of your prescription drugs covered, and how much will they cost? What benefits does each plan include? Do you need vision or dental, and if so, are they included?

• Network: Are your doctors included in the network? Can you seek out-of-network care? Do you have to get a referral to see specialists?

• Quality: What’s the plan's Medicare star rating? How is customer satisfaction?

• Costs: How much are the premiums? What are the plan's deductibles, coinsurance and copays? What's the plan's out-of-pocket maximum?

» MORE: How to compare Medicare Advantage plans

Once you’ve done your research and found a Medicare Advantage plan that fits your needs, there are various ways to enroll, according to Medicare.gov:

• Use Medicare’s plan finding tool to find the plan in your area. Enter your ZIP code to get started.

• Go to the plan’s website, and look for an option to enroll online.

• Contact the plan to get an enrollment form, which you can complete and return.

• Call the plan and join by phone.

• Call Medicare at 800-MEDICARE (800-633-4227).

You will need your Medicare number and the date your Medicare Part A and/or Part B coverage started. You must be enrolled in Medicare Parts A and B before you can buy a Medicare Advantage plan.

If you’re new to Medicare, you can enroll in a Medicare Advantage plan during your initial enrollment period (when you first become eligible for Medicare), when you sign up for Part B for the first time or during a special enrollment period (if you qualify)

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Centers for Medicare & Medicaid Services. Joining a Plan. Accessed Aug 21, 2026. View all sources .

» MORE: Medigap vs. Medicare Advantage: What's the difference?

If you want to switch Medicare Advantage plans, you can do so during Medicare's fall open enrollment period (Oct. 15 to Dec. 7) or Medicare Advantage's open enrollment period (Jan. 1 to March 31).

You also can change to Original Medicare during these periods, but it may be hard to get a Medicare Supplement Insurance policy if you switch after the first year. In most states, insurers are required to issue you a Medigap policy only during your initial Medigap enrollment period (typically the six months after you turn 65 and enroll in Medicare Part B) or if you switch out of your Medicare Advantage plan in the first year. After that, insurers may deny you a Medigap policy if you have health problems, or they can require a waiting period before your pre-existing conditions are covered

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Centers for Medicare & Medicaid Services. Get ready to buy: Your Medigap Open Enrollment Period. Accessed Aug 21, 2026. View all sources .

» MORE: Medicare vs. Medicare Advantage: Which should I choose?

Limited provider choice and changing networks

One of the most common complaints about Medicare Advantage is that your choice of doctors and hospitals is restricted. On average, Medicare Advantage enrollees have access to about half of the physicians available to Original Medicare beneficiaries in their area, according to KFF, a health policy nonprofit

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KFF. Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries. Accessed Aug 21, 2026. View all sources .

Most plans require you to stay in your plan network, and those that don't charge more for going out of it. Networks also vary dramatically by location and can change at any time — your doctor could be in-network one day and out the next, forcing you to switch providers.

The plan itself can disappear, too. In 2026, about 1 in 10 people in Medicare Advantage plans will have to find new coverage because their insurance company stopped offering their plan, according to research published by the American Medical Association

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JAMA. Forced Disenrollments Among Medicare Advantage Beneficiaries Following 2026 Plan Exits. Accessed Aug 21, 2026. View all sources .

Denied and delayed care

People on Medicare Advantage also worry about care being denied or delayed by preapproval requirements. Almost all Medicare Advantage beneficiaries (99%) have plans that require preapproval for certain care. Expensive services like hospital stays, skilled nursing facility stays and home health care most often require this approval.

If a request is denied, you can appeal, and most appeals succeed: About 80% of appealed denials were fully or partially overturned in 2024, according to KFF

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KFF. Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024. Accessed Aug 21, 2026. View all sources .

You might not be able to switch back

Finally, if your health declines and you want to return to Original Medicare, it may be hard to get a Medigap plan. In most states, you can be subject to medical underwriting when you apply for Medigap after your first six-month Medigap open enrollment window. This means insurance companies can charge you more or deny you based on your medical history.

That said, Medicare Advantage premiums are lower than what you’d pay for Original Medicare plus a Medigap plan. And if you can’t afford a Medigap plan, Medicare Advantage offers protection Original Medicare doesn’t on its own: a yearly cap on your out-of-pocket costs.