Medicare Part C, commonly called Medicare Advantage, is a bundled alternative to Original Medicare offered through private insurance companies. These plans cover everything Original Medicare covers (Part A hospital services and Part B medical services), usually include prescription drug coverage (Part D), and often add extras like dental, vision, and hearing benefits that Original Medicare does not provide.
What Part C Is Required to Cover
Every Medicare Advantage plan must, by law, cover all the same services as Original Medicare Parts A and B. That includes hospital stays, doctor visits, lab tests, preventive screenings, outpatient surgery, home health care, skilled nursing facility stays, hospice care, durable medical equipment, and mental health services. If Original Medicare covers it, your Part C plan covers it too.
Most plans also bundle in Part D prescription drug coverage, so you get medications included without needing a separate drug plan. For 2026, insulin cost sharing is capped at $35 per month or less, depending on the specific drug’s negotiated price.
Extra Benefits Beyond Original Medicare
The biggest draw of Medicare Advantage is the supplemental coverage that Original Medicare doesn’t offer. These extras vary by plan, but they’ve become widespread across the market.
Dental: As of 2021, 94% of Medicare Advantage enrollees had access to some dental coverage. This typically includes preventive care like oral exams, cleanings, and X-rays, along with more extensive services such as fillings, extractions, and root canals. The depth of dental coverage varies significantly between plans, so check whether yours covers major procedures or only routine visits.
Hearing: 97% of Medicare Advantage enrollees had access to hearing benefits, with 95% of those enrollees in plans that covered both hearing exams and hearing aids.
Vision: Many plans include routine eye exams and allowances toward glasses or contact lenses, though the dollar amounts and frequency limits differ.
Fitness programs: Original Medicare does not cover gym memberships, but many Medicare Advantage plans include fitness benefits like gym access or structured wellness programs. If your plan offers this, you’ll need to contact them directly to confirm which gyms or programs are included.
Some plans also offer transportation to medical appointments, meal delivery after a hospital stay, or over-the-counter health product allowances. Starting in 2026, CMS has tightened the rules on certain supplemental benefits for people with chronic conditions, specifically banning non-health-related items like alcohol, tobacco, and life insurance from being offered as plan perks.
HMO vs. PPO: How Plan Type Affects Your Coverage
Medicare Advantage plans come in different structures, and the type you choose determines how flexible your coverage is.
HMO plans generally require you to use doctors and hospitals within the plan’s network. You’ll typically need to choose a primary care doctor and get referrals before seeing a specialist. If you go out of network for non-emergency care, the plan usually won’t cover it at all.
PPO plans give you more freedom. You don’t need to choose a primary care doctor or get referrals for specialists. You can see any provider who accepts Medicare, including out-of-network doctors, though you’ll pay more for out-of-network care. Before seeing an out-of-network provider, it’s worth contacting your plan to confirm the services are covered.
Coverage Restrictions to Know About
While Part C covers everything Original Medicare does, it can place additional limits on how and when you access care. The most significant restriction is prior authorization: your plan may require advance approval before covering certain services, tests, or procedures. This doesn’t exist in Original Medicare, where any Medicare-accepting provider can deliver covered services without plan approval.
Network restrictions also matter. Original Medicare lets you see any doctor or hospital in the country that accepts Medicare. With Medicare Advantage, you’re typically limited to the plan’s network for routine care, and going outside it (in non-PPO plans) can mean paying the full cost yourself.
A 2026 rule change does offer new protection on the hospital side. Medicare Advantage plans will no longer be able to retroactively deny a hospital admission they already approved, except in cases of clear error or fraud. Previously, some plans would approve an inpatient stay and later reverse that decision based on information gathered after the fact, leaving patients with unexpected bills.
What You’ll Pay
Medicare Advantage premiums range from $0 to over $200 per month, with the estimated average for 2026 at just $14 per month. You still pay your Part B premium (most people pay the standard amount) on top of any plan premium. Many plans in competitive markets charge no additional premium at all.
Deductibles vary by plan. Most enrollees face the standard Part B deductible of $283 per year, and if the plan includes drug coverage, the Part D deductible maxes out at $615 per year. Some plans waive these deductibles entirely.
One financial advantage Part C has over Original Medicare: a built-in out-of-pocket maximum. Original Medicare has no cap on what you could spend in a year, meaning a serious illness could result in unlimited cost sharing. Medicare Advantage plans are required to set a yearly ceiling on your in-network out-of-pocket costs, giving you a hard limit on your financial exposure.
Who Can Enroll
To join a Medicare Advantage plan, you need to be enrolled in both Part A and Part B, live in the plan’s service area, and be a U.S. citizen or lawfully present in the country. You’ll need your Medicare number and the start dates of your Part A and Part B coverage when you sign up.
Most people enroll during the Annual Enrollment Period, which runs from October 15 through December 7 each year. You can also enroll when you first become eligible for Medicare or during certain Special Enrollment Periods triggered by qualifying life events like moving to a new area. If you’re already in a Medicare Advantage plan and want to switch, the Open Enrollment Period from January 1 through March 31 gives you one chance to change plans or return to Original Medicare.