Medicare Advantage (Part C)
An alternative to Original Medicare in which private insurers administer Medicare benefits, typically offering lower premiums, added benefits (dental, vision, hearing), and network restrictions.
Medicare Advantage (MA) plans are offered by private insurers approved by CMS (Centers for Medicare & Medicaid Services). Enrollees receive their Part A and Part B coverage through the plan rather than directly from Medicare. The federal government pays the plan a capitated monthly amount per enrollee; the insurer manages care within that budget. About 54% of Medicare beneficiaries were enrolled in MA plans as of 2024.
MA plans commonly include benefits not covered by Original Medicare: dental cleanings and basic restorative work, eyeglass allowances ($100–$250/year), hearing aid benefits ($500–$2,000/year), fitness memberships (SilverSneakers), and over-the-counter allowance cards. Monthly premiums range from $0 (plan premium, after still paying the Part B premium) to $100+/month depending on the plan and region.
The critical tradeoff versus Original Medicare is network restriction. Most MA plans are HMOs or PPOs requiring enrollees to use a specific network of physicians and hospitals. Prior authorization is commonly required for specialty care, imaging, surgeries, and high-cost drugs. Denial rates for prior authorization under MA plans have drawn congressional scrutiny, with a 2022 HHS OIG report finding that 13% of denied MA prior authorizations would have been covered under Original Medicare standards.
Real-World Example
A 70-year-old enrolled in a $0-premium HMO Medicare Advantage plan with a $5,000 out-of-pocket maximum, a $250 dental allowance, and a $200 over-the-counter card — saving $2,096/year in Part B premium versus a Plan G Medigap combo, but accepting primary care network restrictions.