Financial Basics · Healthcare

Medicare Advantage

Medicare Advantage (Part C) is private health insurance that replaces Original Medicare. Plans bundle Parts A, B, and usually D, often add dental/vision, and typically use HMO or PPO networks.

By the TRRP Editorial TeamUpdated 2026SSA · IRS · CMS data

Definition

Medicare Advantage (Part C) is private health insurance that replaces Original Medicare. Plans bundle Parts A, B, and usually D, often add dental/vision, and typically use HMO or PPO networks.

Why it matters in retirement

Nearly half of Medicare beneficiaries now choose Advantage plans — usually for the $0 premium and extra benefits. But Advantage plans use prior authorization, narrow networks, and step therapy in ways Original Medicare does not. For healthy retirees the trade-off often makes sense; for those expecting serious illness, it often doesn't.

Key numbers · 2026
Avg premium
$17/mo
Max out-of-pocket (2026)
~$9,350
% of Medicare enrollees
~50%
Denial rate on prior auth
~7–10%
Pros
  • Usually $0 premium
  • Includes dental/vision/hearing
  • Annual out-of-pocket max
  • Fitness/wellness benefits
Cons
  • Narrow networks
  • Prior authorization required for many services
  • Hard to switch back to Original Medicare + Medigap
  • Geographic restrictions

Common mistakes

  • Picking a plan based on premium without checking drug formulary
  • Ignoring whether your doctors are in-network
  • Assuming you can always switch back to Medigap (often you can't)
  • Not re-shopping plans during annual open enrollment
The part most people miss

The moment you're diagnosed with a serious illness is also when Medigap insurers can refuse you coverage. If you think you might ever want Original Medicare, make that decision while you're still healthy and the switch is guaranteed.

When you’re ready

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