Yes, Medicare Advantage (Part C) plans do pay 100% for covered services after you reach your plan's annual maximum out-of-pocket (MOOP) limit, but you pay deductibles, copays, or coinsurance until you hit that limit, and you must keep paying your Part B premium. The specific costs and limit vary by plan, but once the MOOP is met, the plan covers all eligible costs for the rest of the year, providing financial protection.
In contrast, traditional Medicare does not have an out-of-pocket limit for covered services. In 2025, the out-of-pocket limit for Medicare Advantage plans may not exceed $9,350 for in-network services and $14,000 for in-network and out-of-network services combined.
Medicare Advantage plans are difficult to budget, and most plans have high out-of-pocket costs. This is the biggest reason they are bad for some people. With Original Medicare and supplemental Medicare insurance, you pay the bulk of your major medical costs upfront through monthly insurance premiums.
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings).
The Centers for Medicare & Medicaid Services (CMS) has set the standard monthly Part B premium at $202.90 in 2026, an increase of $17.90, or just under 10 percent, from the 2025 premium of $185.00.
Medicare Part B Premium and Deductible
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Excluded services include:
Will my Medicare Advantage Plan help pay my Part B premium? Compare costs for specific health care plans. Varies by plan. Once you pay the plan's limit, the plan pays 100% of your covered health services for the rest of the calendar year.
Plans may offer extra benefits that Traditional Medicare doesn't cover, such as certain vision, hearing, and dental services. While MA plans may be less expensive than Traditional Medicare, they may offer fewer services and a more limited coverage network. Annual out-of-pocket costs are limited.
Medicare Advantage (Part C) plans offer all the benefits of Original Medicare (Part A and Part B), with extras like dental, vision, hearing, and prescription drug coverage. Chronic Special Needs plans (C-SNPs) are designed for people living with qualifying chronic conditions.
For comparison, the Centers for Medicare and Medicaid Services completed almost 400,000 prior authorization reviews for Original Medicare in 2023 and denied 28.8%, or 113,448 of requests received. Centene and CVS Health Medicare Advantage plans had the highest denial rates for prior authorization requests.
The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked. The second way to leave your Medicare Advantage plan is if you've had it for less than one year (that is: you're entitled to a “trial right”).
All-in-one convenience: Medicare Advantage plans bundle hospital, medical and prescription drug coverage into one plan. Most include telehealth services, so you can get care from the comfort of home. Budget-friendly, predictable costs: Unlike Original Medicare, these plans come with an annual out-of-pocket maximum.
Some Medicare Advantage plans may also offer extra benefits, such as routine dental, vision and hearing services. A Medicare Supplement plan, also called Medigap, isn't bundled with anything—it's extra coverage you can buy to help pay the out-of-pocket expenses Original Medicare doesn't pay.
How can a Medicare Advantage plan have a $0 monthly premium? Private insurance companies are able to offer zero-premium Medicare Advantage plans, in part, because: To help manage costs, Medicare Advantage plans usually enter into contracts with a network of doctors and hospitals.
Medicare Advantage plan costs vary depending on where you live. You still have to pay your Part A and Part B monthly premiums, but most plans cover deductibles and coinsurance. Medicare Advantage plans cap your annual maximum out-of-pocket costs.
There are four key disadvantages of choosing a Medicare Advantage plan versus original Medicare:
One of the main reasons why Original Medicare doesn't cover 100% of your medical bills is because it operates on a cost-sharing model. Medicare Parts A and B come with deductibles, coinsurance, and copayments that beneficiaries are responsible for paying.
Medicare Advantage (Part C): In 2026, the out-of-pocket maximum for Part C plans will decrease by $100 to $9,250 for approved services, but individual plans can set lower limits if they wish. Part D cost sharing does not apply toward your Medicare Advantage plan's MOOP.
With Medicare Supplement Plan F, you get the most complete coverage available. And because Plan F also covers costs in excess of Medicare-approved amounts, you may have no out-of-pocket costs for hospital and doctor's office care.
Unfortunately, Original Medicare (Part A and Part B) does not usually cover medication to treat high blood pressure. While Medicare Part B offers some prescription drug coverage, it has limited coverage of most drugs for chronic conditions, including high blood pressure. Learn more about Medicare Part B.
This includes if a medical practitioner: Renders or initiates 80 or more relevant professional attendance services on each of 20 or more days in a 12-month period. This is commonly referred to as the "80/20 rule". Renders or initiates 30 or more relevant phone services on each of 20 or more days and a 12-month period.
With Medicare Part B, you pay 20 percent of the cost for the services you use. So if your doctor charges $100 for a visit, then you are responsible for paying $20 and Part B pays $80. There is no limit on Part B coinsurance costs, which could add up if you have a lot of doctor visits or need other services.