Healthcare Data GlossaryPayer
Medicare Advantage: Definition and Healthcare Context
Full name: Medicare Advantage (Medicare Part C)
Medicare Advantage (Part C) is an alternative to traditional Medicare in which private health plans — approved and paid by CMS — deliver all Medicare-covered benefits plus optional supplemental benefits such as vision, dental, and hearing. CMS reimburses Medicare Advantage plans through risk-adjusted capitation payments. CMS publishes plan performance data including star ratings, enrollment figures, and quality metrics. In 2024, approximately 33 million Medicare beneficiaries — more than 50% of total Medicare enrollment — are enrolled in Medicare Advantage plans.
Last updated: 2026-06-17Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- CMS NPPES NPI Registry: Medicare Advantage plan networks reference NPI records to build and publish provider directories required under the Transparency in Coverage Rule.
- CMS QPP MIPS: clinicians in Advanced APM tracks within Medicare Advantage arrangements may qualify for APM incentive payments instead of MIPS payment adjustments.
Frequently asked questions
- What is Medicare Advantage?
- Medicare Advantage (Part C) is a private health plan alternative to traditional Medicare. Plans are approved and paid by CMS and must cover all Medicare benefits.
- How many people are enrolled in Medicare Advantage?
- As of 2024, approximately 33 million people — more than half of all Medicare beneficiaries — are enrolled in Medicare Advantage plans.
- What are the differences between Medicare Advantage and traditional Medicare?
- Medicare Advantage uses a managed-care model with provider networks, prior authorization, and often supplemental benefits. Traditional Medicare has broader provider access and no prior auth requirement.