Medicare Advantage, also called Medicare Part C, is an alternative way to receive your Medicare benefits. Private insurance companies offer these plans under contracts with Medicare. A Medicare Advantage plan provides your Part A and Part B benefits through the plan, rather than through Original Medicare.

The right plan depends on where you live, the doctors and hospitals you use, the prescriptions you take, and the costs you can manage. This article explains the general rules. Plan availability, benefits, premiums, and cost-sharing vary by county and plan year.

Who can join a Medicare Advantage plan?

You generally must have Medicare Part A and Part B, live in the plan’s service area, and meet Medicare’s eligibility requirements. Medicare’s joining-a-plan guidance says you need both Part A and Part B to join a Medicare Advantage plan, with or without drug coverage.

Texas does not have one statewide Medicare Advantage menu. Plans serve specific geographic areas, and the choices available to you can change from one year to the next. Use Medicare’s Plan Compare tool with your ZIP code to see current options.

What Medicare Advantage plans cover

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, subject to the plan’s rules. Plans may also offer extra benefits, but an extra benefit is not guaranteed in every plan or county.

Most Medicare Advantage plans include Part D drug coverage. These are often called Medicare Advantage Prescription Drug plans, or MAPD plans. You generally cannot join a separate Part D plan while enrolled in Medicare Advantage, unless a specific plan type or situation allows it. Confirm the rule for the plan you are considering before enrolling.

Costs and the annual out-of-pocket limit

A plan may charge a monthly premium, although some plans have a $0 plan premium. A $0 plan premium does not mean the coverage is free. You generally still pay the Medicare Part B premium, unless a program or plan rule applies to your situation. You may also pay deductibles, copayments, or coinsurance when you receive care.

Medicare Advantage plans set their cost-sharing within federal rules and must include an annual out-of-pocket limit for covered Part A and Part B services. After you reach that limit, the plan pays 100% of covered Part A and Part B services for the rest of the year. The limit does not necessarily apply to prescription drugs, premiums, or services the plan does not cover. Check the plan’s Evidence of Coverage for the details.

For current plan-specific premiums, networks, benefits, and limits, compare plans at Medicare.gov Plan Compare. CMS has published official 2027 Medicare Advantage and Part D policy and rate materials, but beneficiary-facing 2027 plan bids, premiums, benefits, formularies, networks, and county-level availability must be checked when Medicare publishes the applicable plan information.

HMO and PPO plans: What is the difference?

Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans are common Medicare Advantage formats.

HMO: You generally use the plan’s network for routine care and may need to select a primary care provider. The plan may require referrals for some specialists. Emergency and urgently needed care have special protections, and the plan’s documents explain any other out-of-network exceptions.
PPO: You can generally use both in-network and out-of-network providers, but out-of-network care usually costs more. The provider must still meet the plan’s rules for the service to be covered.

Networks matter. Before enrolling, ask your doctors, hospitals, and pharmacies whether they participate in the specific plan. A provider’s participation can change, so confirm with both the provider and the plan.

When can you enroll or change plans?

Medicare’s enrollment-period guide explains the main windows:

Initial Enrollment Period: For most people enrolling at 65, this runs from three months before the month you get Medicare through three months after that month. It can differ in some situations.
Medicare Open Enrollment, October 15 through December 7: You can join, switch, or leave a Medicare Advantage plan. Coverage generally begins January 1 if the plan receives the request by December 7.
Medicare Advantage Open Enrollment, January 1 through March 31: If you are already in Medicare Advantage, you can switch to another Medicare Advantage plan or return to Original Medicare and join a separate drug plan.
Special Enrollment Periods: Certain events, such as moving or losing coverage, may create a special enrollment opportunity.

If you are new to Medicare, compare coverage before making a decision. A local State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling, and Medicare also provides plan comparison tools.

Before you act

Use Medicare Plan Compare and the plan’s Evidence of Coverage to check your doctors, prescriptions, benefits, and total costs by ZIP code. Plan availability and benefits change, so confirm details for the year you are considering.

Medicare Advantage Plans in Texas: How They Work