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Medicare Advantage (Part C) plans cover the medically necessary services covered by Original Medicare’s Part A and Part B, but plan rules shape how you get that care and what you pay. Many plans also include prescription drug coverage, and some offer extra benefits. You generally keep paying the Part B premium, and may also owe a plan premium, deductibles, copayments or coinsurance. Those costs—and the plan’s annual limit for covered medical services—vary by plan and location.
What Medicare Advantage must cover
Medicare Advantage plans must cover all medically necessary services that Original Medicare covers under Part A and Part B. That is the coverage floor, not a guarantee that every provider or service is handled under the same rules as Original Medicare. Private plans may set network, referral and prior-authorization requirements that affect how you access covered care.
Most Medicare Advantage plans include Part D prescription drug coverage, but not all do. Check whether a specific plan includes drug coverage before assuming you can use it for prescriptions or that you do not need a separate drug plan. Medicare’s coverage comparison explains the broad differences.
What extra benefits may be included
Some plans offer benefits Original Medicare generally does not, such as dental, vision or hearing services. These benefits are not standard across all plans. The plan documents determine what is covered, who qualifies, how often a benefit can be used, which providers are eligible and whether there is a dollar allowance or added cost.
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Do not rely on a broad benefit label alone. For example, a plan’s dental benefit may have limits or provider restrictions; the specific terms, rather than the category name, determine what you can use.
What you may pay
For 2026, Medicare says Medicare Advantage premiums and other costs—including deductibles, copayments and coinsurance—vary by plan. To remain enrolled, you must have Part B and generally continue paying its premium. Some plans may help pay all or part of the Part B premium, depending on the plan and area; confirm that benefit in the plan’s official materials rather than assuming it applies.
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A plan advertised with a $0 monthly premium does not necessarily mean your total monthly or yearly costs are zero. You may still owe the Part B premium and pay cost sharing when you receive services. Medicare’s 2026 costs page describes the variation in premiums and other plan costs.
The annual limit on covered medical services
Medicare Advantage plans have a yearly out-of-pocket limit for covered health services. Once you reach your plan’s limit, the plan pays 100% of your covered health services for the rest of that calendar year. The amount is plan-specific, so check the limit for the plan you are considering.
This limit is not a cap on every expense. It does not make premiums or services outside the plan’s coverage free, and it should not be treated as a single cap that combines medical costs with prescription-drug costs.
Prescription-drug costs are separate
For 2026, Medicare says a Part D deductible cannot exceed $615, though some plans have no deductible. For covered drugs, the 2026 out-of-pocket threshold before catastrophic coverage begins is $2,100; certain payments made on your behalf can count toward it. These are federal Part D figures, not the premium or total cost of a particular Medicare Advantage plan. Drug coverage and spending stages follow Part D rules. See Medicare’s 2026 costs information for the applicable drug-cost rules.
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How networks and approvals affect access and cost
Medicare Advantage plans use private-plan rules, so a covered service may still involve a particular provider network, referral process or advance approval requirement. Depending on plan type and terms, some plans cover certain non-emergency out-of-network care at higher cost, while others may restrict routine care to the network.
- Check that your doctors, hospitals, specialists and medical suppliers are in the exact plan’s network.
- Confirm whether out-of-network care is covered, what it costs and whether the plan’s out-of-network limit differs from its in-network limit.
- Ask which services, supplies or drugs require prior authorization, and review the plan’s rules for requests and denials.
- Check that your pharmacy is in the plan’s network and that your prescriptions are on its formulary.
Medicare’s guidance for evaluating Medicare Advantage plans highlights networks, authorization, extra-benefit terms and cost limits as issues to compare.
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How to compare plans for your situation
Compare the plan’s actual documents and costs for the year you want coverage. A plan’s summary or marketing page may not show every condition or limitation that matters to your care.
| What to compare | What to verify |
|---|---|
| Expected care | Doctors, hospitals, specialists, suppliers and services you expect to use. |
| Provider access | Network status, out-of-network coverage and cost, referral rules and service area. |
| Prior authorization | Which services, supplies or drugs need advance approval, and what the plan says happens if a request is denied. |
| Medical costs | Plan premium, continuing Part B premium, deductibles, service copayments or coinsurance, and in- and out-of-network medical out-of-pocket limits. |
| Prescription drugs | Whether Part D is included, whether your prescriptions are covered, the pharmacy network and your drug cost sharing. |
| Extra benefits | Eligibility, provider restrictions, frequency or dollar limits, and any added premium or cost. |
| Annual changes | The plan’s Annual Notice of Change and Evidence of Coverage, since benefits, networks and costs may change. |
Original Medicare generally has no annual out-of-pocket limit unless you have supplemental or other coverage. Medicare Advantage does have a yearly limit for covered health services, but that protection needs to be weighed alongside plan cost sharing and provider access.
Where to check official plan information
Use Medicare.gov to compare options available in your area and review the plan documents for the year you are considering. Medicare’s Medicare & You 2026 handbook covers Medicare benefits, costs, rights and plan choices; Medicare also lists official handbook formats through its publications page.
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