Medicare Advantage · Part C
Medicare Advantage plans in 2026: what you get, and what it costs you
Medicare Advantage delivers your Part A and Part B benefits through a private plan, usually with drug coverage and extras. Premiums can be low. The trade-off is networks and copays, and it is worth understanding both before you switch.
Figures reviewed for 2026
How it works
Medicare pays a private insurer to deliver your benefits
With Original Medicare, the federal government pays your claims directly. With Medicare Advantage, it pays a private insurer a set amount each month, and that insurer delivers at least the same coverage. You stay in Medicare, keep paying your Part B premium, and follow the plan’s rules instead of Medicare’s.
In exchange, plans can bundle in things Original Medicare does not cover: drug coverage, dental, vision, hearing aids, gym memberships, and sometimes a partial rebate of your Part B premium. That bundling is why Advantage plans are popular.
What they cannot do is cap your costs without a network. Every plan has an annual out-of-pocket maximum, and until you reach it you pay copays and coinsurance on the services you use. In a heavy medical year, those copays add up before the cap applies.
$9,250
Maximum in-network out-of-pocket limit for 2026
No plan may set a higher in-network limit this year.
$2,100
Annual cap on covered prescription drugs
Applies to drugs covered by the plan.
$0
Monthly premium on many plans
You still pay your Part B premium of $202.90.
Four plan structures
The types of Medicare Advantage plan
The letters matter more than the marketing. Each one describes how the network works and how much freedom you have.
HMO
Health Maintenance Organization. You stay inside the plan network and usually need a referral to see a specialist. Premiums are typically the lowest and networks the tightest.
PPO
Preferred Provider Organization. You can see out-of-network providers for a higher share of the cost. The most flexible Advantage option, and usually the priciest.
PFFS
Private Fee-for-Service. You can see any provider who accepts the plan terms. Very few of these plans remain, and provider acceptance changes, so check before you rely on it.
SNP
Special Needs Plan. Built for a specific group, such as people with both Medicare and Medicaid, certain chronic conditions, or who live in an institution.
The honest trade-off
Positives and negatives, side by side
What works well
- Low or $0 monthly premiums are common
- A hard yearly limit on your out-of-pocket costs
- Most plans include Part D drug coverage
- Many include dental, vision, hearing, and fitness benefits
- You can change plans every year with no health questions
What to watch for
- Copays and coinsurance vary by service, so costs are less predictable
- Network restrictions apply, especially with HMOs
- Care while traveling may be limited or out of network
- Specialist visits usually need a referral on an HMO
- Benefits and provider networks can change each January
When you can enroll or switch
- Initial Enrollment Period: the seven months around your 65th birthday, or when you first qualify.
- Annual Election Period: October 15 through December 7, for coverage starting January 1.
- Medicare Advantage Open Enrollment: January 1 through March 31, for one change if you are already in an Advantage plan.
- Special Enrollment Periods: triggered by moving, losing employer coverage, or a plan leaving your area.
Answers
Medicare Advantage questions
Can I have a Medigap policy and a Medicare Advantage plan at the same time?
No. It is illegal for anyone to sell you a Medigap policy if they know you have a Medicare Advantage plan, unless you are switching back to Original Medicare. If you move to Advantage, your Medigap policy becomes redundant, and dropping it may make it hard to buy again later.
What is the out-of-pocket limit in 2026?
For 2026, an in-network out-of-pocket limit on a Medicare Advantage plan cannot exceed $9,250. Once you reach the plan limit, the plan pays 100 percent of covered health services for the rest of the calendar year. Many plans set their limit well below the maximum.
When can I change Medicare Advantage plans?
The Annual Election Period runs October 15 through December 7 each year, for coverage beginning January 1. There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31, when you may make one change. Special Enrollment Periods apply after certain life events.
Do Medicare Advantage plans cover prescription drugs?
Most do; these are called MA-PD plans. Drug coverage inside an Advantage plan is subject to the same 2026 rule as standalone Part D, including the $2,100 annual out-of-pocket cap on covered drugs. Check the plan formulary against your actual prescriptions before you enroll.
Is Medicare Advantage the same as Original Medicare?
No. You keep your Medicare enrollment and pay your Part B premium, but a private insurer delivers your Part A and Part B benefits under its own rules, network, and cost sharing. Hospice care remains covered by Original Medicare.
Official sources
Check it at the source
Every figure on this page comes from the agencies below. They are the primary record, and none of these links costs you anything.
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