How Medicare Advantage works
You still sign up for Part A and Part B through Social Security. Then you pick an Advantage plan from a private insurer approved by Medicare. That plan pays your claims instead of Original Medicare.
You keep paying your Part B premium, which is $202.90 a month for most people in 2026. Some Advantage plans charge their own premium on top of that, and many charge $0.
Every Advantage plan has to cap what you pay for covered in-network care each year. Once you hit that cap, the plan pays 100% of covered services for the rest of the year. Original Medicare has no cap on its own, which is why people add a Medicare Supplement to it.
The main plan types
Let's break it down. The letters tell you how strict the network is.
| Plan type | Network rules | Referrals | Good fit for |
|---|---|---|---|
| HMO | In-network only, except emergencies | Usually needed for specialists | People happy with one local system |
| PPO | Out-of-network care allowed at a higher cost | Usually not needed | People who want some flexibility |
| SNP | Built for a group, like people with both Medicare and Medicaid | Varies | People who qualify for the special group |
| PFFS | Any provider who accepts the plan's terms | Not needed | Rural areas with thin networks |
What to check before you pick a plan
Premiums get the attention, but they rarely tell the whole story. Check these in order:
- Your doctors and hospitals. Look up every name in the plan's directory, then call the office to confirm.
- Your prescriptions. Check the plan's drug list and tier for each one, plus the pharmacy you use.
- The out-of-pocket limit. This is your worst-case year. Plans set it at or below the federal maximum.
- Copays for care you use. Specialist visits, imaging, outpatient surgery and hospital stays add up fast.
- Prior authorization rules. Many plans need approval before certain tests or procedures.
Advantage plans are sold by county, so the list in one county can look nothing like the list next door. Our local sites track the plans in each market.
When you can join or switch
You can join when you first get Medicare, during Annual Enrollment from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31, when people already in an Advantage plan can make one switch. Moves, losing other coverage and a few other events also open a Special Enrollment Period. See the full list in our enrollment periods guide.