Medicare Advantage

Medicare Advantage, also called Part C, lets people receive their Medicare benefits through private insurers such as HMOs and PPOs instead of the traditional government-run program. The government pays each plan a set monthly amount per enrollee, adjusted for health risk and quality ratings, and the plan must cover everything traditional Medicare covers. Private plans have existed in Medicare since the 1970s, were expanded as Medicare+Choice in 1997, and were renamed Medicare Advantage by the 2003 Medicare Modernization Act.

Enrollment has grown steadily, reaching about 35.2 million people in 2026, or 55 percent of those eligible, up from about one in five in 2007. Most plans include drug coverage, and many offer extra benefits such as dental, vision, hearing, and gym memberships, often with no premium beyond the Part B premium, and they cap yearly out-of-pocket costs. In exchange, most limit enrollees to provider networks and require prior authorization for some services.

Supporters say Medicare Advantage gives seniors choice, coordinated care, extra benefits, and financial protection, and point to its popularity. Critics, including the congressional advisory commission MedPAC, say the government pays plans more than it would spend for the same people in traditional Medicare, largely because plans record more diagnoses that raise payments, and that prior authorization denials can delay care. Government audits and lawsuits over billing practices have continued, and Congress and Medicare regulators debate payment rates and oversight each year.