Medicare Advantage (Part C) Plans

What a Medicare Advantage plan actually includes

An Advantage plan replaces the way you receive Original Medicare. The plan — not the federal government — pays your claims, and it must cover everything Part A and Part B cover. Most plans then add benefits Original Medicare has never included.

• Hospital care (Part A) — inpatient stays, skilled nursing, hospice (hospice stays with Original Medicare even on an Advantage plan).
• Medical care (Part B) — doctor visits, outpatient care, preventive screenings, durable medical equipment.
• Prescription drugs (Part D) — bundled into most plans, which is why they're called MAPD plans.
• Extras — dental, vision, hearing aids, an over-the-counter allowance, fitness memberships, and non-emergency transportation are common but vary enormously between plans.
• A yearly out-of-pocket maximum — once you hit it, the plan pays 100% of covered Part A and Part B services for the rest of the year.

Details and the current federal rules are on Medicare.gov's health plans page.

What it costs in 2026

The headline premium is the least useful number on a Medicare Advantage plan. Here is the full cost picture.

Cost	2026 amount	Notes
Part B premium	$202.90/mo	You keep paying this to Medicare even on an Advantage plan
Part B deductible	$283/yr	Applies under Original Medicare; Advantage plans set their own cost sharing
Plan premium	Often $0	A $0 premium is not a free plan — see the FAQ below
Copays & coinsurance	Varies by plan	Per visit, per service; this is where plans differ most
Out-of-pocket maximum	Set by each plan	Federally required; the single most important number to compare

Part B figures come from the CMS 2026 premiums and deductibles fact sheet; general cost rules are on Medicare.gov's costs page.

HMO vs PPO — the choice that matters most

Nearly every Advantage plan in New Mexico is either an HMO or a PPO, and the difference determines whether your doctor is covered.

	HMO	PPO
Out-of-network care	Generally not covered except emergencies and urgent care	Covered at a higher cost share
Referrals to specialists	Usually required	Usually not required
Monthly premium	Typically lower	Typically higher
Best for	People settled with in-network local doctors	Travelers, snowbirds, people with out-of-area specialists

If you split the year between New Mexico and another state, or you drive to Albuquerque or Denver for a specialist, read the network rules before the premium.

Who Medicare Advantage tends to suit

There is no universally better choice between Advantage and Medigap — it depends on your health, your doctors, your travel, and your tolerance for paperwork.

• You want one card, one plan, and drug coverage bundled in.
• Your doctors and hospital are already in the plan's network.
• You value a lower monthly premium and can absorb copays as you use care.
• The extra benefits — dental, vision, hearing, OTC allowance — are worth real money to you.
• You're comfortable with prior authorization for some services.

People who travel widely, want no networks at all, or want the most predictable yearly cost often lean toward Medigap plus a standalone Part D plan instead.

How plans change every year — and why that matters

Advantage plans are annual contracts. Every fall a plan can change its premium, its copays, its drug formulary, its provider network, and its extra benefits — and plans sometimes leave a county entirely, as New Mexico enrollees saw with recent carrier exits.

That's why the October 15 – December 7 Annual Enrollment Period exists: it's your yearly chance to re-check. If you do nothing, you're automatically renewed into next year's version of your plan, which may not be the plan you chose.

Read your Annual Notice of Change when it arrives each September, and check three things: is my doctor still in network, is my drug still on the formulary at the same tier, and did the out-of-pocket maximum move?

When you can enroll or switch

• Initial Enrollment Period — 7 months — the 3 months before your 65th-birthday month, that month, and the 3 months after.
• Annual Enrollment Period — October 15 – December 7, for coverage starting January 1.
• Medicare Advantage Open Enrollment — January 1 – March 31, if you're already in an Advantage plan you may switch once to another Advantage plan or return to Original Medicare.
• Special Enrollment Periods — moving, losing other coverage, qualifying for Medicaid or Extra Help, or your plan leaving your county.

The official rules are on Medicare.gov's joining a plan page.

Not sure which of these fits you? A free 15-minute call with a licensed local advisor sorts it out — no pressure, and no cost to you. We do not offer every plan available in your area. For a complete list of every plan in your county, use Medicare Plan Compare or call 1-800-MEDICARE.