Medicare Advantage, also called Part C, is a way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare instead of through Original Medicare. Most Medicare Advantage plans also bundle in prescription drug coverage (Part D) and may include extra benefits such as dental, vision, or hearing. You continue to pay your Part B premium, and some plans charge an additional premium.

Original Medicare is the federal Part A and Part B program and has no yearly limit on out-of-pocket costs for covered services. Medicare Advantage provides Part A and Part B benefits through a Medicare-approved private plan, often with Part D and extra benefits. Its medical spending limit applies to covered Part A and Part B services; premiums, Part D drug costs and noncovered services are separate. Networks and other coverage rules vary by plan.

Each Medicare Advantage plan has a yearly out-of-pocket limit for covered Part A and Part B services. The amount varies by plan and year; PPO plans can have separate in-network and combined limits. Premiums, Part D drug spending and noncovered services do not count toward this medical limit. Check the Summary of Benefits and Evidence of Coverage for the year you are considering.

Most Medicare Advantage plans include Part D prescription drug coverage, but some do not. For covered Part D drugs, the annual out-of-pocket threshold is $2,100 in 2026 and $2,400 in 2027. After reaching the applicable threshold, you pay no cost-sharing for covered Part D drugs for the rest of that calendar year. Premiums and noncovered drugs are separate. Confirm the plan’s formulary, pharmacy network and coverage rules for the year you are considering.

You need both Part A and Part B and an applicable enrollment opportunity. Initial timing depends on when you become eligible for both. AEP runs October 15–December 7 for eligible changes starting January 1. People already in Medicare Advantage generally have one change during January 1–March 31 MA-OEP; a first-three-month opportunity or a qualifying Special Enrollment Period may also apply. Confirm eligibility and effective dates before changing coverage.

Plans can change their costs, provider networks, drug formularies, and extra benefits each year, and some insurers reduce or exit service areas. Every fall your plan sends an Annual Notice of Change describing what is different for the coming year. Reviewing it before the Annual Enrollment Period closes helps you confirm your doctors, medications, and benefits are still covered the way you expect.

You stay enrolled in Medicare and continue paying your Part B premium, but a Medicare Advantage plan replaces the way you receive your Part A and Part B benefits while you are enrolled in it. If you later decide Medicare Advantage is not the right fit, you can return to Original Medicare during the enrollment periods described above.

Yes. As a licensed independent agent, Anil Khanchandani can walk you through how Medicare Advantage works and help you compare options so you can make an informed decision based on your doctors, medications, and budget. The goal is clarity before coverage — education first, never pressure.