Medicare Advantage Costs: What You Actually Pay in 2026
Most Medicare Advantage plans charge no premium of their own, but “$0 plan” does not mean “$0 per month.” You still pay the Medicare Part B premium, which is $202.90 a month in 2026 for most people, and then copays, coinsurance and sometimes a deductible whenever you use care. A yearly out-of-pocket maximum caps what you can owe for covered services. This guide walks through each layer of cost, with the 2026 averages and the places where a plan’s real price hides.
TL;DR
- Three layers make up your cost: the Part B premium you always pay, any plan premium, and cost-sharing when you get care.
- Across individual plans with drug coverage, 75% of enrollees pay no premium beyond Part B, and the average plan premium is $15 a month.
- Every plan has an out-of-pocket limit. The average in-network limit in 2026 is $5,421, but the legal ceiling is higher.
- Costs can change only once a year, on January 1, so the fall review is your best chance to catch a bad fit.
Table of Contents
- The three layers of Medicare Advantage cost
- Monthly premiums: what a $0 plan really means
- Deductibles, copays and coinsurance
- The out-of-pocket maximum
- Why your costs can differ from your neighbor’s
- A worked example: three kinds of year
- How to check the real cost of a specific plan
- Get help comparing plans near Rockford
- FAQ
- Sources
The three layers of Medicare Advantage cost
It helps to stop thinking of a Medicare Advantage plan as having one price. It has three.
- Premiums. The Part B premium goes to Medicare. A plan premium, if there is one, goes to the insurance company.
- Cost-sharing. Deductibles, copayments and coinsurance are what you pay when you see a doctor, enter a hospital or fill a prescription.
- The cap. Your plan’s maximum out-of-pocket limit stops the cost-sharing from growing without end.
The official Medicare handbook says members must keep paying the Part B premium and may also pay plan premiums, deductibles, copayments and coinsurance. Each plan sets its own amounts, so two plans in the same zip code can look very different once you use them.
Monthly premiums: what a $0 plan really means
The Part B premium comes first
In 2026 the standard Part B premium is $202.90 a month, and you have to keep paying it to stay in a Medicare Advantage plan. Higher earners pay more. Income-related surcharges apply on top of Part B, and our guide to the 2026 IRMAA income lines and appeal steps explains who is affected.
So a plan advertised at $0 still means about $202.90 leaving your Social Security check or bank account each month, unless you qualify for help or a plan with a giveback benefit. Some local plans return part of the Part B premium to members. We cover how that works, and who it suits, in our Medicare giveback benefit guide.
Plan premiums are usually small
Most plans charge nothing extra. In 2026, 75% of enrollees in individual plans with drug coverage pay no premium other than Part B. The average supplemental premium across individual plans, zeros included, is $15 a month.
Here is what that looks like for one person:
| Monthly item | Example plan A | Example plan B |
|---|---|---|
| Part B premium (2026 standard) | $202.90 | $202.90 |
| Plan premium | $0 | $15 |
| Monthly total before care | $202.90 | $217.90 |
The $15 figure is an average used for illustration. It is not a quote for any specific plan. A plan with a modest premium can still be the cheaper choice if it has lower copays for the care you use, and a $0 plan can cost more over a year if you take expensive drugs or see specialists often.
Deductibles, copays and coinsurance
This is where Medicare Advantage plans differ most. Deductibles, copayments and coinsurance are set by each plan and vary. They are what you pay for services or drugs, after any deductible applies.
A few ways to read a plan’s cost-sharing table:
- Copayment: a flat dollar amount, such as a set fee for a primary care visit or a specialist visit.
- Coinsurance: a percentage of the cost, which matters most for hospital stays, outpatient surgery and some drugs.
- Deductible: an amount you pay first before the plan starts sharing costs. Some plans have a medical deductible, a separate drug deductible, both or neither.
In general, Medicare Advantage plans often have lower cost-sharing for many services than Original Medicare. For comparison, Original Medicare charges a Part A inpatient hospital deductible of $1,736 in 2026, and many Advantage plans charge a daily copay for hospital days instead. Lower sticker prices on routine care are one reason plans appeal to people who rarely need a hospital. The tradeoff is that the cost of a serious illness depends on that plan’s specific rules.
Prescription drug costs
Most Advantage plans include Part D drug coverage, and the drug piece has its own deductible, tiers and copays. Which pharmacy you use and whether your drugs are on the plan’s formulary change the price a lot. Our Part D explainer on costs, formularies and the end of the donut hole covers the rules, and a prescription plan review shows what your own list of drugs would cost under each plan.
The out-of-pocket maximum
The maximum out-of-pocket limit is the feature that most separates Medicare Advantage from Original Medicare, which has no annual cap. Once you hit your plan’s limit, the plan pays 100% of covered health services for the rest of the calendar year.
What the averages look like in 2026
| Measure (2026 average) | Amount |
|---|---|
| In-network limit, all plans | $5,421 |
| In-network plus out-of-network combined | $9,825 |
| HMO in-network limit | $4,636 |
| PPO in-network limit | $6,592 |
The cap that plans may not exceed is higher than these averages. We break down the $9,250 in-network ceiling for 2026 and what it leaves out in our guide to the Medicare Advantage MOOP. The practical point: a plan with a $3,500 limit and one with a $9,000 limit can both be “legal,” and the gap is real money in a bad year.
What the cap does not cover
The cap applies to covered Medicare services. Your monthly premiums do not count toward it. Neither does anything the plan does not cover, and costs for care outside the network can be higher or fall under a separate combined limit. Prescription drugs are usually handled under Part D rules rather than the medical limit, so check how your plan treats them.
One more caution: you cannot buy a Medigap policy to cover your Medicare Advantage out-of-pocket costs. If you want predictable costs from the first dollar, that is a reason to compare Advantage against a Supplement. We lay out the differences in Medicare Advantage vs. Medicare Supplement.
Why your costs can differ from your neighbor’s
Two people in the same plan can pay very different amounts in a year. Medicare says costs depend on the plan’s network, which services you need and how often you use them, plus the plan’s own set rates.
The main drivers:
- Network. Seeing a doctor outside the network can cost more, or not be covered at all in some HMOs.
- Plan rules. Costs can vary with whether you follow plan rules such as prior authorization. These restrictions are rarely used in traditional Medicare.
- Your health. A healthy person may spend only the premiums and a few copays. Someone with cancer, heart disease or frequent hospital stays can reach the cap.
- Where you live. Plans are sold by county, so the options in Rockford, Roscoe or Beloit are not the same list. Our pages for Beloit, Roscoe and Byron cover the local picture.
- Other coverage. When Medicare and another payer such as Medicaid are both involved, coordination of benefits rules decide who pays first.
A worked example: three kinds of year
These are illustrations built on the averages above, not predictions for a real plan. Assume the Part B premium of $202.90 and a plan with no premium and a $5,421 limit.
| Year | Care used | What you pay on top of Part B |
|---|---|---|
| Quiet | A few primary care visits, generic drugs | Small copays, well under the limit |
| Moderate | Specialist visits, imaging, an outpatient procedure | A few hundred to a few thousand dollars in copays and coinsurance, depending on the plan |
| Serious | Multi-day hospital stay, surgery, follow-up care | Up to the plan’s out-of-pocket limit, then covered services are paid in full |
Part B alone comes to $2,434.80 over twelve months at $202.90 (12 × $202.90). Add that to the cap in the serious year to see the real worst case for covered services: the plan’s limit plus roughly $2,435 in Part B premiums, plus any plan premium and drug costs that sit outside the cap.
How to check the real cost of a specific plan
Plan details are published each fall for the following January 1, and what members pay can only change once a year, on January 1. That makes the fall review the moment to compare. You can look up and compare costs for specific plans on Medicare.gov. When you do, look at these in order:
- Your doctors and hospital. Confirm each one is in the network.
- Your prescriptions. Enter every drug and your pharmacy to get a yearly drug estimate.
- The out-of-pocket limit. Look at in-network and combined limits.
- Copays for what you actually use. Specialists, therapy, imaging, ambulance, hospital days.
- Extras you would use. Dental, vision, hearing, and giveback benefits, weighed against what they cost.
Check the plan’s Evidence of Coverage for the rules on prior authorization and referrals before you enroll, not after a claim is denied.
If you are turning 65, also consider timing. Missing your enrollment windows for Part B or Part D can add permanent penalties, which raise your costs regardless of the plan you choose. Our Medicare costs overview for 2026 puts every premium and deductible side by side.
Get help comparing plans near Rockford
Almond Insurance is a family-run Medicare agency in Rockford, Illinois, serving Northern Illinois and Southern Wisconsin. We compare Medicare Advantage, Supplement and Part D options side by side, walk through your doctors, drugs and expected care, and review your plan every year. You do not pay us for that guidance, because carriers compensate the agency when a client enrolls in a plan.
Ready to see what your own numbers look like? Start with our plan comparison service, or see everything we offer on our services page. If you are new to Medicare and want the basics first, Medicare 101 is a good place to begin.
FAQ
How much do Medicare Advantage plans cost per month?
You pay the Part B premium, $202.90 in 2026 for most people, plus whatever your plan charges. The average plan premium is $15 a month, and about three-quarters of enrollees in plans with drug coverage pay no premium beyond Part B. Your total depends on income-related surcharges too.
Is a $0 premium Medicare Advantage plan really free?
No. The plan does not charge its own premium, but you still pay Part B. You also pay copays, coinsurance and any deductible when you use care, up to the plan’s yearly limit. Compare the total cost for the care you expect, not just the premium.
What is the most I can pay out of pocket in a year?
That is your plan’s maximum out-of-pocket limit, and it varies by plan. In 2026 the average in-network limit is $5,421, and the ceiling plans may set is higher. After you reach it, the plan pays covered services in full for the rest of the year. Premiums and non-covered services do not count toward it.
Can I switch back to Original Medicare if the costs are too high?
Yes, you can leave a Medicare Advantage plan, but timing rules apply, and going back to Original Medicare may mean buying a Supplement and a separate drug plan. Medigap insurers may also review your health in some situations. Talk with a licensed agent or call 1-800-MEDICARE before you cancel, so you are never without coverage.
When can my plan’s costs change?
Only once a year, on January 1. Plans send notices in the fall, so read yours and compare it against other plans during the annual enrollment period each fall.
Sources
- Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits and Prior Authorization
- How Much Do People with Medicare Pay for Coverage?
- Understanding Medicare Advantage Plans (Medicare.gov)
- Medicare costs (Medicare.gov)
- Understanding health plan costs (Medicare.gov)
- 2026 Medicare Parts A & B Premiums and Deductibles (CMS)