What a Medicare Advantage plan actually is
When you join a Medicare Advantage plan, a private insurance company approved by Medicare takes over the delivery of your Part A and Part B benefits. You must keep paying your Part B premium ($202.90 per month in 2026), you keep your Medicare rights and protections, and the plan must cover everything Original Medicare covers. On top of that base, most plans add prescription drug coverage and extras such as dental allowances, vision exams, hearing aids or fitness memberships.
In exchange, you agree to play by the plan rules: a provider network (HMO or PPO), possible referrals for specialists, and copays or coinsurance as you use care. Every plan sets a yearly out-of-pocket maximum, a genuinely valuable protection that Original Medicare alone does not have.
How the money works in 2026
| Cost item | What you pay on a typical Advantage plan |
|---|---|
| Plan premium | Often $0 to modest, varies by county and plan |
| Part B premium | $202.90 per month in 2026 (higher with IRMAA) |
| Primary care visit | Low fixed copay, sometimes $0 |
| Specialists, tests, hospital days | Copays and coinsurance set by the plan |
| Yearly out-of-pocket maximum | Caps your medical spending for the year; resets January 1 |
| Prescriptions | Plan formulary pricing; $2,100 out-of-pocket cap on covered drugs in 2026 |
The pattern to understand: Advantage plans shift cost from the premium to the point of care. You save every month you stay healthy and pay copays in the months you need treatment, with the out-of-pocket maximum as your worst-case backstop.
HMO or PPO: the network question
HMO plans generally require you to use network providers and get referrals, in exchange for lower costs. PPO plans let you go out of network at a higher price and usually skip referrals. In Palm Beach County and most of South Florida, both types compete heavily, which works in your favor; in rural counties the choices thin out. This is exactly the kind of local detail we check for every client before recommending anything.
Who Advantage tends to fit, and who it does not
- Often a strong fit: your doctors are in network, you like one card and one bill, you want dental and vision baked in, and you value a low monthly premium.
- Often a poor fit: you split the year between two states, you insist on any specialist anywhere without referrals, or you are managing a condition where copays would pile up every single month.
Advantage plans are re-filed every single year: networks, drug lists, copays and extras all move. The plan that won for you in 2024 is not automatically the winner in 2026. An annual re-check takes twenty minutes and is included, free, for every client.