Which type of care is not covered by Medicare? It’s a common question among older adults age 65+. The fact is that original Medicare (Parts A and B) doesn’t cover everything—and it may not be comprehensive enough for your healthcare needs. If that’s the case, you may want to consider enrolling in a Medicare Advantage plan.

What is Medicare Advantage?

Medicare Advantage plans, also referred to as Part C plans, are private health plans that have contracts with Medicare. If you decide to enroll in a Medicare Advantage plan, your Medicare-covered health care services go through the private plan instead of the federal government. In other words, you still have Medicare, but you receive your benefits in a different way.

Medicare Part C plans typically require the use of in-network providers that have contracts with the Medicare Advantage plan, including doctors, hospitals, drug stores and other healthcare providers. The use of providers outside the plan’s network may incur additional costs or not be covered by Medicare.

What do Medicare Advantage plans cover?

Medicare Advantage plans include Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). That means they cover basic health care services like doctor visits, hospital stays, short-term nursing home stays, and diagnostic and laboratory tests.

• Vision /eyeglasses
• Hearing / hearing aids
• Dental
• Health club memberships
• Medically necessary transportation
• Special debit cards to pay for groceries, toiletries, vitamins, etc.
• Rideshare services (some plans)

Many Medicare Advantage plans also include prescription drug coverage (Part D). If you plan does now, you'll need to enroll in a separate Part D plan if you want coverage for your medications.

"Medicare Advantage plans can be an appealing option for many older adults because they bundle hospital, medical, and often prescription drug coverage and other benefits into one plan," said Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. "The key is making sure your plan's network, costs, and extra benefits actually fit your needs and budget."

How much does Medicare Advantage cost?

Enrollment in Medicare Parts A and B is a requirement to join a Medicare Advantage plan. Monthly Part B premiums must be paid. The Part B premium ($202.90 in 2026)usually comes out of your Social Security checks automatically, but you should confirm with plans directly before deciding to enroll.

You may also pay an additional monthly premium on top of the Part B premium and, for some services, a deductible and a portion of the cost of the services you receive. In 2026, the average monthly Medicare Advantage premium is $14.00. This additional premium helps pay for the extra benefits some Medicare Advantage plans offer their members. The structure of costs varies across different Medicare Advantage plans.

You may be able to get help paying out-of-pocket Medicare Advantage costs if you qualify for Medicaid or Medicare Savings Programs. You typically must have low income and meet other requirements to be eligible for assistance.

What are the different types of Medicare Advantage plans?

There are five different types of Medicare Advantage plans available:

1. Health Maintenance Organizations (HMOs) - If care is not received from an HMO-approved provider, called an in-network provider, Medicare will not cover it. A referral is typically needed from a primary care provider to see a specialist.
2. Medical Savings Accounts (MSAs) - A high deductible must be paid before the plan covers any benefits. A health savings account is linked to the plan and Medicare puts money in the savings account each year. But the amount is less than the annual deductible.
3. Preferred Provider Organizations (PPOs) - You can receive care from a Medicare provider who is out-of-network, but the costs are higher. A primary care doctor is not needed.
4. Private Fee-for-Service plans (PFFS) - There is no network of providers. Any Medicare provider who agrees to the plan’s terms and payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary.
5. Special Needs Plans (SNPs) - These are PPOs or HMOs that only admit people with Medicare who have certain conditions. Learn more .

Enrolling in both Medicare Advantage and Medigap (supplemental insurance) is not allowed. If you’re enrolled in a Medicare Advantage plan, you cannot purchase a Medigap policy. Once enrolled in an Part C plan, there are limited opportunities to switch to a Medigap policy plus original Medicare in the future. It’s important to understand your choices before you enroll in a plan. 

For help choosing a Medicare Advantage plan, contact your State Health Insurance Assistance Program (SHIP) and speak to a trained counselor for free. Find your local SHIP here.