Medicare Advantage (Part C) plans do not pay 100% of all healthcare costs immediately. They operate with deductibles, copayments, and coinsurance until a maximum out-of-pocket (MOOP) limit is reached. Once this annual limit (up to $9,350 in 2025) is met, the plan typically covers 100% of covered services.
Medicare Advantage Plan (Part C):
Deductibles, coinsurance, and copayments vary based on which plan you join. Plans also have a yearly limit on what you pay out-of-pocket. Once you pay the plan's limit, the plan pays 100% for covered health services for the rest of the year.
If you join a Medicare Advantage Plan you'll still have Medicare, but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
Of course, no Medicare Advantage plan is really $0 cost. You may still pay deductibles and copays for covered services, and you'll still have to pay the Part B premium. But depending on your own personal healthcare needs, a Medicare Advantage plan may be worth it for the added benefits.
Medicare Advantage plans have a yearly limit on out-of-pocket costs. Once you reach that limit, you won't pay anything for covered services. However, each plan can have a different limit and that limit may change every year. You'll want to use health care providers within your plan's network for the lowest costs.
People leave Medicare Advantage (MA) plans due to difficulty accessing needed care (especially with worsening health), restrictive provider networks, complex prior authorization rules, and dissatisfaction with care quality, often feeling trapped as their health needs grow despite initial low costs and extra perks that become limiting. Issues with provider availability, network changes, and sometimes misleading marketing also drive disenrollment, pushing people back to Traditional Medicare for greater freedom, notes KFF.
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
Across the country, health systems report that Medicare Advantage's growing administrative burden — from denied authorizations to delayed reimbursements — has become unsustainable. Some hospitals have already ended their contracts; others are limiting participation to only a few select plans.
This Medicare Advantage “trap” occurs because, although it is easy to switch from traditional Medicare to MA, in 46 states it is can be very costly, if not impossible, to switch from MA to traditional Medicare.
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.
Simply put, a growing majority of seniors choose MA because it provides better and more coordinated care, more comprehensive benefits, better outcomes and increased savings and financial security compared to FFS Medicare. For most Medicare-eligible patients, these advantages are available for no additional premium.
Yes, you can switch back to Original Medicare from a Medicare Advantage plan during specific enrollment periods (like the Annual Enrollment Period: Oct 15–Dec 7, or the MA Open Enrollment: Jan 1–Mar 31) or via Special Enrollment Periods (SEPs) for life events, but you may need to buy a Medigap plan separately and face underwriting for it. Joining a Part D drug plan when you switch automatically disenrolls you from your Advantage plan, making the transition seamless for drug coverage.
The "best" Medicare plan for seniors depends on individual needs, but top-rated providers for Medicare Advantage (Part C) in 2026 include Humana, UnitedHealthcare, Aetna, and Blue Cross Blue Shield (BCBS), offering nationwide coverage, large networks, $0 premium options, and extra benefits like dental/vision, while Medigap (Medicare Supplement) plans like Plan F provide comprehensive Original Medicare cost coverage. Key factors are your doctors, prescriptions, budget, and preference for network flexibility (MA) or broad coverage (Medigap).
Medicare Advantage plans pay physicians an estimated 10% to 15% less than what is paid by the government in traditional Medicare, according to the 2025 Omniscient Health Physician Medicare Income Report.
Supplemental insurance is advisable for those with Medicare to help cover out-of-pocket costs and gaps in coverage, offering financial protection for deductibles, coinsurance, and other medical expenses not fully covered by Medicare.