Medicare Part C continues to grow in 2026, with more than half of all Medicare beneficiaries now enrolled in these privately administered plans, also known as Medicare Advantage. Enrollment has steadily increased over the past decade, and current federal data show that Medicare Advantage plans cover a majority of eligible seniors nationwide. As plan options expand and benefits evolve, understanding how Part C works has become essential for millions of Americans.
This guide breaks down what Medicare Part C includes in 2026, how it differs from Original Medicare, what it costs, and how enrollment rules apply today.
Table of Contents
What Is Medicare Part C?
Medicare Part C, commonly called Medicare Advantage, is an alternative way to receive Medicare benefits. Private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS) administer these plans.
Every Medicare Advantage plan must cover:
- Medicare Part A (hospital insurance)
- Medicare Part B (medical insurance)
Most plans also include:
- Medicare Part D (prescription drug coverage)
- Additional benefits such as dental, vision, and hearing
Although private insurers operate the plans, CMS regulates them and sets coverage standards.
How Many Americans Are Enrolled in Medicare Advantage in 2026?
Medicare Advantage enrollment continues to rise. Recent federal enrollment data show that more than 30 million people are enrolled in Medicare Advantage plans nationwide. That figure represents over half of all Medicare beneficiaries.
Enrollment growth reflects increased plan availability and added supplemental benefits.
Many counties across the United States now offer multiple plan options, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs).
How Medicare Part C Works
When a beneficiary enrolls in a Medicare Advantage plan, the federal government pays a fixed amount to the private insurer. The plan then manages the individual’s Medicare benefits.
Instead of receiving coverage directly from the federal government, members receive services through the insurer’s provider network.
Most plans require:
- Using network doctors and hospitals
- Referrals for specialists in HMO plans
- Prior authorization for certain procedures
PPO plans offer more flexibility but may charge higher out-of-pocket costs for out-of-network services.
Medicare Part C Costs in 2026
Costs vary by plan and location. However, all Medicare Advantage enrollees must continue paying their Medicare Part B premium.
In 2026, the standard Medicare Part B monthly premium remains adjusted annually by CMS. Beneficiaries with higher incomes may pay Income-Related Monthly Adjustment Amounts (IRMAA).
In addition to the Part B premium, some Medicare Advantage plans charge:
- A monthly plan premium (some plans offer $0 premiums)
- Copayments for doctor visits
- Coinsurance for hospital stays
- Annual deductibles
One key feature of Medicare Advantage is the annual out-of-pocket maximum. Original Medicare does not include this protection.
In 2026, plans must set an annual limit on in-network out-of-pocket spending. Once a beneficiary reaches that cap, the plan covers 100% of covered services for the remainder of the year.
Benefits Often Included in Medicare Advantage
Medicare Advantage plans frequently include supplemental benefits beyond Original Medicare.
Common extras include:
- Dental coverage
- Vision exams and eyewear
- Hearing aids
- Fitness memberships
- Transportation to medical appointments
Some plans also offer meal delivery after hospital stays and over-the-counter allowances.
Coverage details vary by insurer and region. Beneficiaries must review plan documents carefully during enrollment.
Special Needs Plans (SNPs)
Special Needs Plans are a type of Medicare Advantage plan designed for specific groups.
There are three primary SNP categories:
- Dual Eligible SNPs (D-SNPs) for individuals eligible for both Medicare and Medicaid
- Chronic Condition SNPs (C-SNPs) for individuals with certain health conditions
- Institutional SNPs (I-SNPs) for individuals in long-term care facilities
These plans tailor provider networks and drug formularies to meet specialized healthcare needs.
Enrollment rules for SNPs require proof of eligibility.
Enrollment Periods in 2026
Understanding enrollment timelines is critical.
Initial Enrollment Period (IEP)
Begins three months before turning 65, includes the birth month, and extends three months after.
Annual Enrollment Period (AEP)
Runs from October 15 to December 7 each year. Coverage changes take effect January 1.
Medicare Advantage Open Enrollment Period
Runs from January 1 to March 31. During this period, beneficiaries already enrolled in Medicare Advantage may switch plans or return to Original Medicare.
Missing enrollment windows can result in delayed coverage changes.
Differences Between Original Medicare and Medicare Advantage
Here is a comparison table for clarity:
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Provider Network | Nationwide access | Network-based |
| Prescription Coverage | Separate Part D plan required | Often included |
| Out-of-Pocket Maximum | None | Required annually |
| Supplemental Benefits | Limited | Often included |
| Referrals | Not required | Required in many HMOs |
Original Medicare allows broader provider flexibility. Medicare Advantage often offers lower upfront costs and additional benefits.
Star Ratings System
CMS assigns Medicare Advantage plans a Star Rating from 1 to 5.
Ratings evaluate:
- Quality of care
- Member satisfaction
- Customer service
- Preventive care performance
Plans with higher ratings may receive performance bonuses from CMS. Beneficiaries often review Star Ratings when comparing plan options.
In 2026, five-star plans remain available in select regions.
Prescription Drug Changes in 2026
Medicare Advantage plans that include drug coverage must follow federal guidelines for Part D benefits.
Recent federal updates have focused on reducing prescription drug costs. A cap on out-of-pocket prescription drug spending began phasing in during 2024 and continues to apply in 2026.
Beneficiaries now benefit from a maximum annual out-of-pocket cap for Part D-covered medications. This change significantly reduces financial exposure for high-cost prescriptions.
Prior Authorization and Oversight
CMS continues to monitor prior authorization practices within Medicare Advantage plans.
Federal regulators require plans to follow strict timelines when reviewing authorization requests. Plans must provide clear explanations for coverage denials.
Appeal rights remain available for beneficiaries who disagree with plan decisions.
Oversight efforts aim to balance cost management with access to medically necessary services.
Geographic Availability
Medicare Advantage plans operate on a county-by-county basis.
Most U.S. counties now offer multiple plan options. Urban areas typically provide a wider selection than rural regions.
Plan availability can change annually. Beneficiaries should review local offerings during the Annual Enrollment Period.
Who Should Consider Medicare Advantage?
Medicare Advantage may appeal to beneficiaries who:
- Prefer bundled coverage
- Want dental, vision, and hearing benefits
- Are comfortable using provider networks
- Value having an annual out-of-pocket cap
Those who travel frequently or prefer unrestricted provider access may favor Original Medicare instead.
Healthcare needs, prescription costs, and provider preferences should guide the decision.
Current Policy Outlook
As of 2026, Medicare Advantage remains a central component of the federal Medicare program.
Enrollment continues to increase. CMS maintains regulatory oversight. Plan competition remains strong in many states.
Policymakers continue to evaluate payment structures and quality benchmarks, but no structural elimination of Medicare Advantage has been announced.
The program remains fully operational nationwide.
Key Takeaways for 2026
- Medicare Advantage covers more than half of Medicare beneficiaries.
- All plans must include Part A and Part B benefits.
- Many plans include Part D drug coverage.
- Annual out-of-pocket caps protect beneficiaries.
- Enrollment periods remain fixed each year.
Careful comparison remains essential before choosing a plan.
Medicare Part C continues to shape how millions of Americans receive healthcare coverage in 2026. With rising enrollment, expanded benefits, and evolving drug cost protections, understanding how these plans work helps beneficiaries make informed decisions.
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