Medicare Advantage Is a Private Insurance Takeover of Your Government Health Benefits

🔑 10 Key Takeaways You Need Right Now

Medicare Advantage is not “better Medicare” — it’s private insurance that replaces your Original Medicare benefits with a managed care plan run by a for-profit (or sometimes nonprofit) insurer that gets paid a fixed amount per enrollee by the federal government.

Medicare Advantage and Medicare Supplement (Medigap) are completely different products — MA replaces Original Medicare with a private plan; Medigap supplements Original Medicare by filling its cost-sharing gaps. You cannot have both simultaneously.

The federal government is projected to overpay Medicare Advantage plans by $76 billion in 2026 alone — largely due to “upcoding” practices where insurers inflate patient diagnoses to receive higher per-member payments, according to the Center for Medicare Advocacy and MedPAC.

13% of Medicare Advantage prior authorization denials violated Medicare coverage rules, per the HHS Office of Inspector General — meaning those services would have been approved under Original Medicare. When beneficiaries appeal, over 80% of denials are overturned, but only 1% of people ever file an appeal.

The average Medicare Advantage premium in 2026 is just $14/month (with 67% of plans charging $0) — but lower premiums mask higher out-of-pocket costs when you actually get sick, with maximum annual limits reaching $9,250 in-network and $13,900 combined.

99% of Medicare beneficiaries have access to at least one Medicare Advantage plan, and 97% can choose from 10 or more — but rural states like Wyoming, Montana, and Alaska may offer as few as 1–5 plans per county with narrower networks and fewer $0-premium options.

The four types of Medicare coverage are Part A (hospital), Part B (medical), Part C (Medicare Advantage), and Part D (prescription drugs) — Parts A and B are “Original Medicare” run by the government; Part C is the private-plan alternative; Part D can be standalone or bundled into an MA plan.

Anyone enrolled in Medicare Parts A and B who lives in the plan’s service area can join a Medicare Advantage plan — there are no additional health screenings, income requirements, or age restrictions beyond standard Medicare eligibility.

The worst-rated Medicare Advantage plans in 2026 score 2.0–2.5 stars out of 5, and CMS flags consistently low performers with a warning icon on Medicare Plan Finder — yet these plans continue to operate and enroll new members.

Switching back from Medicare Advantage to Original Medicare can be medically and financially devastating — in most states, if you’ve been in an MA plan for more than 12 months, you lose your guaranteed-issue rights to purchase a Medigap policy without medical underwriting, potentially leaving you uninsurable for supplemental coverage.

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🏛️ Original Medicare vs. Medicare Advantage: One Is Government Insurance, the Other Is a Corporate Contract

This is the foundational distinction that every Medicare beneficiary must understand before making any enrollment decision. Original Medicare (Parts A and B) is a federal insurance program administered directly by the Centers for Medicare & Medicaid Services. When you have Original Medicare, the government pays your doctors and hospitals directly. You can see any provider in the country who accepts Medicare — and roughly 97% of non-pediatric physicians do.

Medicare Advantage (Part C) is something entirely different. When you enroll in an MA plan, you are leaving the government program and transferring your Medicare benefits to a private insurance company. The government then pays that company a fixed monthly amount for your care (called a “capitated payment”), and the insurer takes over responsibility for covering your healthcare services. The company profits when it spends less on your care than the government paid it.

🏛️ Feature	🔵 Original Medicare (Parts A + B)	🔴 Medicare Advantage (Part C)
👤 Who administers it	Federal government (CMS)	Private insurance companies (UnitedHealthcare, Humana, Aetna, BCBS, Kaiser, etc.)
🏥 Provider choice	Any doctor or hospital in the US that accepts Medicare (97% of physicians)	Must use plan’s network (HMO) or pay significantly more out-of-network (PPO)
📋 Prior authorization	Rarely required — doctors decide treatment	Frequently required — insurer must approve treatment before you receive it
💰 Monthly premium (beyond Part B)	$0 for Parts A and B coverage itself	Average $14/month; 67% of plans charge $0
🔒 Out-of-pocket maximum	None — no annual cap on spending	Required by law: up to $9,250 in-network / $13,900 combined (2026)
🦷 Dental, vision, hearing	Not covered under Original Medicare	96–99% of MA plans include some dental, vision, and hearing benefits
💊 Prescription drugs	Requires separate Part D plan	Usually included (roughly 90% of MA plans bundle Part D)
🌍 Coverage when traveling	Nationwide — any Medicare-accepting provider	Typically limited to plan’s service area; emergency-only coverage elsewhere
📝 Supplemental coverage	Can purchase Medigap policy to fill gaps	Cannot buy Medigap while enrolled in MA
📊 How insurer is paid	Government pays providers directly per service (fee-for-service)	Government pays insurer a fixed monthly amount per enrollee (capitated)

The financial incentives are worth examining closely. Under Original Medicare, the government pays for each service you receive — so there’s no structural incentive to deny care. Under Medicare Advantage, the insurer receives the same fixed payment whether you use $500 or $50,000 in medical services that year. Every dollar not spent on your care is a dollar of potential profit for the insurance company. This capitated model creates a built-in financial tension between the company’s profitability and your access to care.

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🚫 Medicare Advantage Is Not Medicare Supplement — and Confusing Them Is One of the Most Expensive Mistakes Seniors Make

This confusion costs beneficiaries thousands of dollars and sometimes their health. Medicare Advantage and Medicare Supplement (Medigap) serve opposite purposes and cannot be used together.

🔍 Feature	🔴 Medicare Advantage (Part C)	🟢 Medigap (Medicare Supplement)
🎯 What it does	Replaces Original Medicare entirely	Supplements Original Medicare — fills gaps in Parts A and B
🏛️ Relationship to Original Medicare	You leave Original Medicare when you enroll	You must keep Original Medicare to use Medigap
🏥 Provider network	Restricted to plan’s network	No network — use any Medicare-accepting provider nationwide
💰 Premium range (2026)	$0–$200+/month (average $14)	$75–$450+/month depending on state, age, and plan letter
🔒 Out-of-pocket protection	Annual cap of up to $9,250–$13,900	Some plans cover nearly all cost-sharing (Plan G covers everything except the $283 Part B deductible)
💊 Prescription drug coverage	Usually included	Never included — must buy separate Part D plan
🦷 Dental/vision/hearing	Usually included (basic benefits)	Never included
📋 Prior authorization	Common — insurer must approve many treatments	None — your doctor decides treatment; Medicare approves billing
🔄 Switching flexibility	Can switch to Original Medicare + Medigap, but may face medical underwriting for Medigap	Can keep indefinitely; guaranteed-renewable by law
⚠️ Biggest risk	Care denials, network restrictions, plan changes annually	Higher monthly premiums; no dental/vision/hearing built in

Here’s the critical trap that catches thousands of seniors every year: if you enroll in a Medicare Advantage plan and later want to return to Original Medicare with a Medigap policy, most states do not guarantee you can purchase Medigap without medical underwriting once your initial 6-month open enrollment window has passed. If you’ve developed cancer, heart disease, diabetes, or other conditions while in your MA plan, insurers in most states can deny your Medigap application or charge significantly higher premiums. This effectively locks you into Medicare Advantage.

Only a handful of states offer ongoing Medigap protections:

🗺️ State Medigap Protections Beyond Federal Minimum	Details
🟢 New York	Community-rated pricing; continuous open enrollment for all Medigap plans year-round
🟢 Connecticut	Continuous open enrollment for all Medigap plans; guaranteed issue year-round
🟢 Massachusetts	Continuous open enrollment; standardized plans unique to the state
🟢 Maine	Guaranteed issue once per year
🟢 California	“Birthday rule” — can switch Medigap plans within 30 days of birthday annually
🟢 Oregon	Annual 30-day Medigap open enrollment for MA enrollees switching back
🟢 Missouri	Guaranteed issue for 65+ switching from MA within 63 days
🟡 21 states total	Offer some form of annual guaranteed-issue protection beyond federal minimum
🔴 29 states + D.C.	Only federal minimum protections — initial 6-month window only

If you live in a state without strong Medigap protections, your decision to join Medicare Advantage should be treated as potentially permanent. This is rarely disclosed during enrollment marketing.

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💰 Who Actually Pays for Medicare Advantage? Taxpayers — and They’re Paying Far More Than They Would for Original Medicare

Medicare Advantage is funded entirely by the federal government through taxpayer dollars. Here’s the money trail:

Every Medicare beneficiary generates a “benchmark” payment amount based on Original Medicare spending in their county. When someone enrolls in an MA plan, CMS pays the insurer a risk-adjusted capitated rate derived from that benchmark. The insurer then uses this payment to cover the enrollee’s healthcare — and keeps whatever margin remains.

The systemic problem is this: the Committee for a Responsible Federal Budget estimates that Medicare Advantage will be overpaid by $1.2 trillion over the coming decade. MedPAC reports that CMS pays an additional $84 billion on Medicare Advantage enrollees compared to what it would spend if those same beneficiaries were in traditional Medicare. For 2026 specifically, Medicare Advantage plans are projected to be overpaid by $76 billion, largely due to upcoding practices that inflate diagnoses.

💰 Who Pays What in Medicare Advantage	Amount / Detail
🏛️ Federal government (taxpayers)	Pays insurer a risk-adjusted capitated rate per enrollee per month — average ~$1,200–$1,500/month per beneficiary
👤 Beneficiary	Part B premium ($202.90/month) + MA plan premium (average $14/month; often $0) + copays, coinsurance, and deductibles when receiving care
🏥 Providers (doctors, hospitals)	Typically paid less by MA plans than by Original Medicare — reimbursement rates set by insurer, not CMS
💼 Insurance company	Receives government payment, pays providers, keeps margin as profit. Top MA insurers collectively earned billions in annual profits

The risk-adjustment system is where the most concerning practices occur. MA plans receive higher payments for sicker patients, which creates an incentive to make enrollees appear as sick as possible on paper. CMS estimates that 9.5% of payments to MA organizations are improper, mainly due to unsupported diagnoses submitted by the plans. Multiple OIG audits have ordered refunds from major insurers including Humana, CVS Health, Blue Care Network of Michigan, and others for diagnosis codes that couldn’t be supported by medical records.

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⚠️ The Real Problems With Medicare Advantage That Marketing Brochures Won’t Show You

The HHS Office of Inspector General, MedPAC (Medicare Payment Advisory Commission), Kaiser Family Foundation, and multiple Congressional investigations have documented systematic problems with Medicare Advantage. These aren’t theoretical concerns — they’re patterns confirmed by federal audits.

Problem 1: Prior Authorization Denials That Violate Medicare Rules

A central concern about the capitated payment model is the potential incentive for insurers to deny beneficiary access to services in an attempt to increase profits. The OIG’s landmark study found that 13% of prior-authorization requests denied by MA plans met the clinical coverage rules of traditional Medicare, and 18% of payment denials met both Medicare coverage rules and MA billing rules.

The denial problem compounds because only 11% of beneficiaries go through the appeals process, and of those appeals, 80% were either partially or fully overturned. According to the American Medical Association’s physician survey, 94% of physicians reported that prior authorization requirements delay access to necessary care, and 78% reported that this process has likely led to patients abandoning treatment.

In February 2026, the OIG released its first major compliance guidance update for Medicare Advantage since 1999, specifically warning plans to review denial trends and ensure they don’t inappropriately restrict coverage. The guidance also flagged concerns that CMS warned in a February 2024 memo against denial decisions based solely on artificial intelligence algorithms that do not account for an individual’s circumstances.

Problem 2: Network Restrictions That Limit Your Doctors

Under Original Medicare, you can see any of the roughly 1.3 million healthcare providers nationwide who accept Medicare. Under Medicare Advantage, you’re restricted to the plan’s network. HMO-style plans typically provide no coverage for out-of-network care except in emergencies. PPO-style plans cover out-of-network providers but at significantly higher cost-sharing.

Problem 3: Plans Change Every Year — Benefits You Counted on Can Disappear

Medicare Advantage plans can change their networks, formularies, benefits, premiums, copays, and even their service areas annually. Your cardiologist might be in-network this year and out-of-network next year. Your diabetes medication might be covered in January and dropped from the formulary by the following January. Several major insurers, including Humana and Aetna, have pulled their MA plans from certain counties and states in recent years to improve profit margins.

Problem 4: The “Medigap Trap” — Once You’re In, You May Not Be Able to Leave

As detailed above, returning to Original Medicare after being enrolled in MA for more than 12 months means losing federal guaranteed-issue rights for Medigap in most states. If you’ve developed health conditions during your time in Medicare Advantage, you may face medical underwriting, higher premiums, or outright denial when trying to purchase a Medigap policy.

⚠️ Medicare Advantage Problem	Scope of Impact	What Federal Investigators Found
📋 Improper prior authorization denials	Millions of denials issued annually across all MA plans	OIG: 13% of PA denials met Medicare coverage rules and should have been approved
💸 Overpayments from diagnosis upcoding	$76 billion projected overpayment in 2026	CMS: 9.5% of MA payments are improper; mostly unsupported diagnoses
🏥 Network adequacy gaps	Varies by plan and geography	CMS audits have flagged inadequate networks, particularly for behavioral health and specialty care
🔄 Annual plan benefit reductions	Affects all MA enrollees when plans change	Major insurers have exited counties, reduced benefits, or raised costs to recover margins
🤖 AI-driven denial algorithms	Industry-wide concern	CMS issued 2024 warning against AI-only denial decisions; OIG monitoring ongoing

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📋 The 4 Types of Medicare Plans: A Complete Breakdown

When people say “the four types of Medicare,” they’re referring to Parts A, B, C, and D. But the practical choice every beneficiary faces is really between two pathways:

Pathway 1: Original Medicare + Medigap + Part D (three separate components working together)

Pathway 2: Medicare Advantage (Part C) (one bundled plan that typically includes drug coverage)

📋 Plan Type	What It Is	Who Runs It	2026 Cost Summary
🏥 Part A — Hospital Insurance	Covers inpatient hospital stays, skilled nursing (up to 100 days), hospice, some home health	Federal government	$0 premium for most; $1,736 deductible per hospital benefit period
🩺 Part B — Medical Insurance	Covers doctor visits, outpatient care, preventive services, equipment, mental health	Federal government	$202.90/month standard premium; $283 annual deductible; 20% coinsurance
🔄 Part C — Medicare Advantage	Private plan that replaces Parts A and B; often includes Part D drug coverage, dental, vision, hearing	Private insurers (UnitedHealthcare, Humana, Aetna, BCBS, Kaiser, Centene/Wellcare, etc.)	Average $14/month beyond Part B premium; copays vary; $9,250 max OOP in-network
💊 Part D — Prescription Drug Coverage	Covers outpatient prescription medications	Private insurers (standalone or bundled into MA)	Average $34.50/month standalone; $615 max deductible; $2,100 annual OOP cap

Within Medicare Advantage, there are several sub-types:

🔄 MA Plan Type	How It Works	Best For
🏥 HMO (Health Maintenance Organization)	Must use network providers; need referrals for specialists; no out-of-network coverage except emergencies	People who want lower costs and are comfortable staying within one health system
🏥 PPO (Preferred Provider Organization)	Can see out-of-network providers at higher cost; no referrals needed	People who want more flexibility and are willing to pay more for it
🏥 PFFS (Private Fee-for-Service)	Plan determines how much it pays providers and how much you pay; providers must agree to plan’s terms	Less common; may offer broader access but fewer protections
🏥 SNP (Special Needs Plan)	Tailored for specific populations: dual-eligible (Medicare + Medicaid), chronic conditions, or institutional (nursing home)	Dual-eligible beneficiaries; people with specific chronic conditions; nursing home residents
🏥 MSA (Medical Savings Account)	High-deductible plan paired with a savings account that Medicare deposits money into	People comfortable with high deductibles who want an HSA-style approach

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🗺️ Medicare Advantage Plan Availability, Premiums, and Star Ratings: State by State in 2026

The Medicare Advantage experience varies enormously depending on your zip code. Metropolitan areas typically have 30–50+ plan options with fierce competition driving premiums down. Rural counties may have fewer than 5 plans with narrower networks and fewer $0-premium choices.

Over 99% of Medicare beneficiaries can choose from at least one MA plan, and 97% have 10 or more options. But “having options” doesn’t mean having good options — the quality, network breadth, and benefit richness of those plans differ dramatically.

🗺️ State/Region	Plan Availability (2026)	Market Characteristics	Key Insurers
🌴 Florida	40+ plans per county in metro areas	Highest MA penetration in the nation; intense competition; many $0-premium plans	UnitedHealthcare, Humana, Aetna, Devoted Health, Florida Blue
☀️ California	30+ plans in urban counties; fewer in rural north	Wide variation by region; Kaiser strong in certain markets	Kaiser, UnitedHealthcare, Aetna, SCAN, Alignment Health
⭐ Texas	25–35 plans in metro areas	Growing market; dual-eligible SNP plans expanding rapidly	UnitedHealthcare, Humana, Aetna, BCBS Texas, Wellcare
🗽 New York	20–30 plans in NYC metro; fewer upstate	Strong Medigap protections make MA less dominant; some community-rated markets	UnitedHealthcare, Healthfirst, Fidelis, EmblemHealth, Aetna
🏭 Pennsylvania	20–30 plans in most counties	Competitive market with strong regional BCBS presence	UPMC, Highmark, UnitedHealthcare, Aetna, Geisinger
🌽 Ohio	20–30 plans in metro counties	Solid competition; BCBS strong regionally	Medical Mutual, UnitedHealthcare, Humana, Aetna, Molina
🏔️ Colorado	15–25 plans	Growing market; Kaiser has strong presence in Front Range	Kaiser, UnitedHealthcare, Humana, Aetna, Anthem
🌲 Rural Midwest / Mountain West (WY, MT, ND, SD)	3–8 plans per county	Limited competition; fewer $0-premium options; narrower networks	UnitedHealthcare, Humana (limited presence); BCBS affiliates
🐻 Alaska	1–5 plans	Least competitive MA market in the nation; limited provider networks	Very few options; Original Medicare + Medigap often more practical
🏝️ Hawaii	10–15 plans	Kaiser dominates; HMSA (local BCBS affiliate) strong	Kaiser, HMSA, UnitedHealthcare
🌸 Puerto Rico	15–20+ plans	High MA penetration; unique market dynamics; rates calculated differently by CMS	Triple-S, MMM, PMC, Molina, MCS

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⭐ The Best and Worst Medicare Advantage Insurers in 2026: What Star Ratings Actually Reveal

CMS rates every Medicare Advantage contract on a 1-to-5 star scale across roughly 40–45 quality measures spanning outcomes, patient experience, access, and processes. The overall average MA Star Rating for 2026 was 3.66, largely the same as 2025’s average of 3.65. Just over 40% of MA contracts earned at least four stars.

Plans rated 4 stars or higher receive a 5% quality bonus payment from CMS, which they can use to enhance benefits for members. Plans rated below 3 stars for multiple consecutive years receive a “low performing” warning icon on Medicare Plan Finder.

⭐ Insurer	2026 Star Performance	Member Distribution	Notable Details
🟢 Kaiser Permanente	Consistently 4.0–5.0 stars across contracts	Regional (CA, CO, GA, HI, MD/DC/VA, OR, WA)	Integrated care model; highest ratings nationally; limited geographic availability
🟢 UnitedHealthcare	3.5–4.0+ across most contracts; 78% of members in 4+ star plans	National (largest MA insurer by enrollment)	Scale advantages; some contracts underperform; subject of ongoing scrutiny
🟡 Aetna (CVS Health)	3.0–4.0+ range; 81% of members in 4+ star plans	National	Reducing plan offerings in some markets; emphasizing quality over growth
🟡 Humana	Average 3.61; largest contract (H5216) below 4 stars; only ~20% in 4+ star plans	National (second-largest MA insurer)	Significant star ratings challenges; pulling out of some markets
🟡 BCBS affiliates	3.5–4.0 typically; varies by state affiliate	Regional / state-based	BCBS Michigan, Illinois, and Texas ranked highest in respective J.D. Power state surveys
🟡 Centene/Wellcare	Improving; shifted ~19.5% of membership to 4+ star plans in 2026	National (focus on dual-eligible and lower-income populations)	Government-program specialist; improving quality trajectory
🔴 Low-performing plans	2.0–2.5 stars for multiple consecutive years	Various contracts flagged by CMS	CMS flags these with warning icons; beneficiaries should strongly consider alternatives

The star ratings tell an important story: this year, 63.5% of membership is attributed to a 4+ star plan, down slightly from 64.1% the prior year. Enrollment in 5-star plans remains negligible, at just 2.3% of members — down from a peak of 27% in 2022. The dramatic decline from 27% to 2.3% in five-star plan enrollment reflects CMS tightening its scoring methodology, not a sudden collapse in care quality — but it does reveal that many plans that previously appeared “excellent” were benefiting from inflated ratings.

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🎯 Who Is Eligible for Medicare Advantage — and Who Should Actually Enroll?

Eligibility for Medicare Advantage is straightforward. You qualify if you meet all three conditions: you are enrolled in Medicare Part A and Part B, you live in the plan’s service area, and you do not have End-Stage Renal Disease (with a significant exception — as of 2021, people with ESRD can now enroll in MA plans during the Annual Election Period, reversing a decades-long exclusion).

But eligibility and suitability are very different questions. Medicare Advantage tends to work well for some populations and poorly for others:

🎯 Medicare Advantage May Work Well For	⚠️ Medicare Advantage May Be Problematic For
✅ Healthy seniors who rarely need specialist care and want low premiums	❌ People with complex chronic conditions requiring frequent specialist visits
✅ People who are comfortable using a specific hospital system and its affiliated doctors	❌ People who travel frequently or split time between states (“snowbirds”)
✅ Low-income beneficiaries who can’t afford Medigap premiums and need dental/vision/hearing	❌ People with established relationships with doctors who may not be in every MA network
✅ Dual-eligible beneficiaries (Medicare + Medicaid) who can access D-SNP plans	❌ People who may need complex care in the future (cancer treatment, transplants, rare diseases)
✅ People in competitive metropolitan markets with many high-rated plan choices	❌ People in rural areas with limited plan options and narrow networks
✅ People who want one bundled product instead of managing multiple coverage components	❌ People who value unrestricted provider choice above all else

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🔄 How to Switch, When to Switch, and the Irreversible Consequences Nobody Mentions

The enrollment windows for Medicare Advantage are:

📅 Enrollment Period	Dates	What You Can Do
🟢 Initial Enrollment Period (IEP)	7-month window around your 65th birthday	Join any available MA plan for the first time
🟢 Annual Election Period (AEP)	October 15 – December 7 each year	Switch between Original Medicare and MA, or switch between MA plans; changes effective January 1
🟡 Medicare Advantage Open Enrollment (MA OEP)	January 1 – March 31 each year	Current MA enrollees can make one change: switch MA plans or drop MA to return to Original Medicare + Part D
🟢 Special Enrollment Periods (SEPs)	Varies by qualifying event	Move to new service area, gain/lose Medicaid, 5-star plan switch, institutional care, and other qualifying circumstances
🔴 5-Star SEP	December 8 – November 30	Switch once to a 5-star rated plan (if available in your area)

The most important warning: if you return to Original Medicare after being in Medicare Advantage for more than 12 months, you will almost certainly need a Medigap policy to avoid Original Medicare’s unlimited cost-sharing exposure. But in 29 states plus D.C., insurance companies can medically underwrite your Medigap application, meaning they can deny coverage or charge dramatically higher premiums based on health conditions you’ve developed.

Only four situations guarantee federal Medigap rights after leaving MA: you’re within your first 12 months of MA enrollment and it was your first time in an MA plan; your MA plan leaves your area or stops participating in Medicare; the plan committed fraud or misled you about coverage; or you move out of the plan’s service area. Outside these scenarios, your Medigap options depend entirely on your state’s consumer protection laws.

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❓ Frequently Asked Questions

What exactly is a Medicare Advantage plan? A Medicare Advantage plan is a private health insurance policy, approved by CMS, that contracts with the federal government to deliver all Medicare Part A and Part B benefits. When you enroll, you leave Original Medicare and receive your healthcare through the insurer’s network of providers. The government pays the insurer a fixed monthly amount for your care. Most MA plans also include Part D drug coverage and extra benefits like dental, vision, and hearing that Original Medicare doesn’t offer.

Is a Medicare Advantage plan the same as a Medicare Supplement? No — they are fundamentally different and mutually exclusive products. Medicare Advantage replaces Original Medicare with a private managed-care plan. Medicare Supplement (Medigap) keeps you on Original Medicare and adds a policy that pays some or all of the cost-sharing gaps (deductibles, coinsurance, copays). You cannot have both at the same time. If you enroll in Medicare Advantage, any existing Medigap policy becomes essentially useless (insurers are required to suspend or terminate it).

Why do some people say Medicare Advantage plans are bad? Federal investigations have documented structural problems including inappropriate prior authorization denials that block access to medically necessary care, upcoding practices that cost taxpayers tens of billions annually, network restrictions that limit provider choice, annual benefit changes that create instability, and the “Medigap trap” that can lock seniors into MA plans even when their needs change. These aren’t fringe concerns — they’re findings from the HHS Office of Inspector General, MedPAC, the Government Accountability Office, and Congressional oversight committees.

Who offers Medicare Advantage plans in 2026? The largest MA insurers by enrollment are UnitedHealthcare (the nation’s largest), Humana (second-largest), Aetna/CVS Health, Blue Cross Blue Shield affiliates (varying by state), Kaiser Permanente (regional), Centene/Wellcare, Cigna/HCSC (following acquisition), Molina Healthcare, Devoted Health, Alignment Health, and dozens of regional and local insurers. The specific plans available to you depend entirely on your county and zip code.

Who pays for Medicare Advantage? Taxpayers fund Medicare Advantage through the same Medicare Trust Fund that pays for Original Medicare. The federal government pays private insurers a risk-adjusted monthly amount for each enrolled beneficiary. Beneficiaries continue paying their Part B premium ($202.90/month in 2026) plus any additional MA plan premium. When you receive care, you also pay copays, coinsurance, and deductibles set by the plan, up to the annual out-of-pocket maximum.

What are the worst Medicare Advantage plans? CMS identifies consistently low-performing plans (2.0–2.5 stars for multiple consecutive years) with a warning icon on Medicare Plan Finder. These plans have demonstrated poor performance in outcomes, patient experience, access to care, and/or claims processing. Rather than naming specific contracts (which change annually), the best approach is to check your specific plan’s star rating at Medicare.gov’s Plan Finder tool before every Annual Election Period. Any plan rated below 3.0 stars deserves serious scrutiny, and any plan flagged with the low-performing icon should prompt you to consider switching.

Can I switch from Medicare Advantage back to Original Medicare? Yes, during the Annual Election Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31). However, returning to Original Medicare without a Medigap policy exposes you to unlimited cost-sharing under Part B’s 20% coinsurance. If you’ve been in MA for more than 12 months and have developed health conditions, purchasing Medigap may be difficult or impossible in states without ongoing guaranteed-issue protections. This is the single most important long-term consideration when initially choosing Medicare Advantage.

Are Medicare Advantage premiums really $0? Many MA plans advertise $0 monthly premiums, and approximately 67% of plans charge no premium beyond the Part B premium you’re already paying. But $0-premium plans are not “free” — they still have copays, coinsurance, deductibles, and out-of-pocket maximums when you actually use healthcare. A $0-premium HMO plan might charge $40–$75 per specialist visit, $300–$500 per day for hospital stays (up to 5–7 days), and 20–40% coinsurance for certain procedures. The annual out-of-pocket limit can reach $9,250 in-network, meaning you could spend up to $9,250 per year in cost-sharing despite paying nothing in monthly premiums.

Does my state affect which Medicare Advantage plan I should choose? Enormously. Your state determines how many plans are available, which insurers compete in your market, how provider networks are structured, and — most critically — what Medigap protections you’ll have if you later want to leave Medicare Advantage. Before enrolling in any MA plan, research your state’s Medigap guaranteed-issue laws, check which local hospitals and physician groups participate in the plan’s network, and review the plan’s star rating and prior authorization policies. What works brilliantly in Miami may be a terrible choice in rural Montana.