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 (also called Part C).
Find out how Medicare Advantage works, what it covers, how plans might change in 2027, and how to decide if it’s right for your health needs and budget.
Snapshot: Original Medicare vs Medicare Advantage
| Original Medicare |
Medicare Advantage | |
|---|---|---|
| Who provides it? | Federal government |
Private insurance company |
| Provider choice | Any provider that accepts Medicare |
Usually limited to a provider network |
| Prescription drugs | Separate Part D plan needed |
Included with most plans |
| Extra benefits | Generally not included |
Often includes dental, vision, hearing, and more |
| Annual changes? | Core benefits remain fairly stable (out-of-pocket costs may change) |
Benefits and costs can change each year |
What is Medicare Advantage?
Medicare Advantage 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 not, you'll need to enroll into another Medicare Advantage plan that does include prescription drug coverage.
"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."
Can my Medicare Advantage plan change every year?
Yes, it can. Your Medicare Advantage plan’s monthly premium, copays, provider network, prescription drug coverage, and extra benefits could change next year. This is different from original Medicare, which generally provides consistent Part A and Part B coverage from year to year (although premiums and other out-of-pocket costs may change).
If you have Medicare Advantage, you should review your Annual Notice of Change (ANOC) each fall to see what’s being adjusted and whether your plan still works for you.
"The ANOC outlines exactly how your Medicare Advantage or Part D plan will change effective January 1, 2027,” Ramsey recently told U.S. News & World Report. “Don't assume a plan that worked well in 2026 will remain your best option. Even modest changes to costs, drug coverage or provider networks can significantly affect both access and affordability. This is especially true for the upcoming year. Overall, Medicare changes happening in 2027 may make it a bit more challenging for older adults to find affordable, accessible coverage and keep their health care and prescription drug costs under control.”
What changes are coming to Medicare Advantage in 2027?
Reports indicate that several major insurers are reducing benefits or increasing cost sharing as they reassess their Medicare Advantage offerings for 2027. Insurers may:
- Increase per-visit copays or annual out-of-pocket spending caps.
- Scale back or eliminate extra benefits, like dental and vision coverage or transportation assistance.
- Leave certain service areas entirely (meaning members must choose new coverage or consider original Medicare).
- Discontinue certain plans.
- Cap enrollment for certain plans, meaning you may not be able to enroll in a plan you prefer.
Specific changes depend on your plan and where you live; not everyone enrolled in Medicare Advantage will pay more or lose benefits.
“These Medicare Advantage changes reflect a complex mix of rising health care costs, insurer financial and market decisions, and federal payment policies,” Ramsey explained. “Before choosing your coverage for 2027, you should make it a priority to understand how they might affect your health care, finances, and access to services.”
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, projected to rise to $209.50 in 2027, based on the 2026 Medicare Trustees Report) 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 for your Medicare Advantage plan 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. According to the Centers for Medicare & Medicaid Services (CMS), this is projected to decrease to $12.00 in 2027. 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. Medicare Advantage plans include an annual maximum out-of-pocket limit for covered Part A and Part B services. Once you reach that limit, the plan pays covered costs for the remainder of the year.
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:
- 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.
- 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.
- 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.
- 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.
- Special Needs Plans (SNPs) - These are PPOs or HMOs that only admit people with Medicare who have certain conditions. Learn more.
Can I have both Medicare Advantage and Medigap?
No. Enrolling in both Medicare Advantage and Medigap (supplemental insurance) is not allowed. Medigap policies cannot be used with Medicare Advantage plans. If you want Medigap coverage, you'll generally need to return to original Medicare, and you may have to answer health questions as part of the Medigap application process (called medical underwriting).
Depending on your health, an insurer could deny your application or charge a higher premium, where allowed by state law.
Learn more about how Medigap works and what questions to ask before purchasing a Medigap policy.
Who can help me choose a Medicare Advantage plan?
For help choosing a Medicare Advantage plan and understanding the changes affecting coverage and costs in 2027, contact your State Health Insurance Assistance Program (SHIP) and speak to a trained counselor for free. Find your local SHIP here.
Frequently asked questions
Will Medicare Advantage cost more in 2027?
Medicare Advantage could cost you more in 2027, even if your monthly premium stays the same or goes down. Some plans may raise copays, bump up annual out-of-pocket limits, or cut extra benefits. Your costs will depend on your plan the care you need.
Check you plan's Annual Notice of Change and compare total costs, including premiums, deductibles, copays, and coinsurance.
How do I compare Medicare Advantage plans in my area?
Start by making a list of the doctors, hospitals, and prescription drugs that are most important to you and your health. Then compare each plan's monthly premium, copays, provider network, drug coverage, maximum out-of-pocket limit, and extra benefits like dental or vision care. Start with the Medicare plan finder tool on Medicare.gov. Medicare Star Ratings can also help you compare the quality of different plans.
Does Medicare Advantage include prescription drug coverage?
Yes, most Medicare Advantage plans do. These plans, known as MAPDs (Medicare Advantage Prescription Drug plans), roll your medical and prescription drug coverage into one plan. But not every Medicare Advantage plan has drug coverage, so be sure to check the plan details carefully before you enroll.
Can I keep my doctor with Medicare Advantage?
It depends. Most Medicare Advantage plans have provider networks, which means you'll typically need to use doctors, hospitals, and other providers that participate in the plan. Before enrolling, check to see whether your preferred doctors and specialists are in the plan's network. If keeping your current providers is important, review provider networks carefully before you settle on a plan.
