What Is Medicare Advantage?

Medicare Advantage — also called Medicare Part C — is an alternative way to receive your Medicare benefits. Instead of getting coverage directly through the federal government (Original Medicare), you enroll in a private insurance plan that contracts with Medicare to provide your Part A and Part B benefits, and usually Part D (prescription drugs) as well.

Enrollment in Medicare Advantage has grown significantly over the past decade. As of 2025, more than half of all Medicare beneficiaries are enrolled in a Medicare Advantage plan. The appeal is understandable: many plans have $0 premiums and include extras like dental, vision, hearing, and gym memberships that Original Medicare doesn't cover.

Most Medicare Advantage plans operate as either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). With an HMO, you must use doctors and hospitals within the plan's network and typically need a primary care physician referral to see a specialist. Going out of network usually means you pay the full cost yourself.

PPO plans offer more flexibility — you can see out-of-network providers, but at a higher cost. Even with a PPO, you'll generally pay less by staying in-network. If you have established relationships with specific doctors or specialists, verifying that they're in-network before enrolling is critical.

One of the most significant — and least discussed — features of Medicare Advantage is prior authorization. Before approving many services, procedures, or specialist referrals, the insurance company requires advance approval. Studies have consistently shown that prior authorization denials are common, and the appeals process can be slow and stressful when you need care quickly.

With Original Medicare, there is no prior authorization requirement for most covered services. If Medicare covers it and your doctor orders it, you generally get it. This difference in control over your own healthcare is a major reason many people with complex medical needs prefer Original Medicare paired with a Medigap plan.

The choice between Medicare Advantage and Original Medicare + Medigap comes down to what you value most. Medicare Advantage often has lower upfront costs and includes extra benefits — but comes with networks, prior authorization, and coverage that can change each January 1. Original Medicare + Medigap offers broader provider access and more predictable costs, but at a higher monthly premium.

There is no single right answer — the best choice depends on your health, your doctors, your prescriptions, and your budget. An independent broker can walk you through a side-by-side comparison based on your specific situation, at no cost to you.