Updated June 17, 2026
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Open the calculatorIn 2026, many Medicare Advantage plans charge $0 in monthly plan premiums, but every enrollee must still pay the standard Part B premium of $202.90 per month. Beyond that, you pay copays or coinsurance for services you use, up to a plan-set annual out-of-pocket maximum. Total annual costs vary significantly from plan to plan and from person to person depending on health needs.
Layer 1: The Part B Premium You Cannot Escape
No matter which Medicare Advantage plan you join, you must remain enrolled in Medicare Part B, and you must keep paying the Part B premium. In 2026, the standard monthly premium is $202.90, according to CMS's official 2026 cost fact sheet. That works out to approximately $2,435 per year for most beneficiaries, before any other Medicare expenses.
Beneficiaries with higher incomes pay more. The income-related monthly adjustment amount (IRMAA) applies to individuals with modified adjusted gross income above $109,000 and married couples filing jointly above $218,000. At the highest income tier, the total Part B premium can reach approximately $689.90 per month in 2026.
Layer 2: The Medicare Advantage Plan Premium
Separate from Part B, your Medicare Advantage plan may charge its own monthly premium. Many plans in major markets offer $0 plan premiums, meaning the only premium you pay is Part B. Others charge anywhere from a few dollars to over $100 per month depending on the plan's benefits, the insurer, and the geographic area.
A lower plan premium does not always mean lower total cost. Plans with $0 premiums may have higher copays for specialist visits or hospital stays. Read the Summary of Benefits for any plan you are considering before you enroll. You can compare plan premiums side-by-side at Medicare.gov's official Plan Finder.
Layer 3: Deductibles
Some Medicare Advantage plans charge a medical deductible that you must meet before the plan begins paying. Others charge no medical deductible at all. If your plan includes prescription drug coverage (a Medicare Advantage Prescription Drug plan, or MAPD), there may be a separate Part D drug deductible. Plans can charge up to the standard Part D deductible limit set by CMS, though many plans set it lower or waive it for certain drug tiers.
Layer 4: Copays and Coinsurance
After meeting any deductible, you typically pay a fixed copay or a percentage (coinsurance) each time you receive a covered service. Common examples include:
- Primary care visits: often $0 to $15 per visit on many plans
- Specialist visits: often $30 to $50 or more per visit
- Urgent care: often $50 to $90 per visit
- Inpatient hospital stays: often a fixed daily copay for the first few days, then $0 for additional days (though this varies widely)
- Emergency room visits: typically a copay in the range of $90 to $120 or more, often waived if admitted
These are approximate ranges. Actual amounts depend on your specific plan. Always verify with the plan's Summary of Benefits or by calling the plan directly.
Layer 5: The Annual Out-of-Pocket Maximum
Every Medicare Advantage plan is required by law to cap your in-network out-of-pocket spending each calendar year. Once you reach that limit, the plan covers 100% of in-network covered services for the remainder of the year. This protection does not exist in Original Medicare unless you add a Medigap supplement.
The cap amount varies from plan to plan. CMS sets a maximum ceiling that plans cannot exceed, but many plans set their caps well below that ceiling. Some plans also set a separate, higher cap for combined in-network and out-of-network spending (relevant mainly for PPO plans). When comparing plans, check both the in-network cap and the combined cap if you sometimes use out-of-network providers.
To see what a plan's actual out-of-pocket maximum is and how it compares to others in your area, use our free Medicare Advantage cost calculator alongside the Medicare Plan Finder.
A Realistic Annual Cost Estimate
| Cost Component | Approximate 2026 Amount |
|---|---|
| Part B premium (standard, 12 months) | ~$2,435/year |
| Medicare Advantage plan premium (example: $0/month plan) | $0/year |
| Medical deductible (if plan charges one) | $0 to several hundred dollars |
| Copays and coinsurance for services used | Varies widely by health status |
| Annual out-of-pocket maximum (in-network) | Varies by plan; check the Plan Finder |
Extra Benefits and Their Value
Many Medicare Advantage plans include benefits that Original Medicare does not cover, such as routine dental care, vision exams and eyewear, hearing aids, gym memberships, and over-the-counter allowances. These extras can have real monetary value, but they vary significantly between plans and between years. Do not choose a plan based primarily on extra benefits without also evaluating its cost-sharing structure and provider network for the medical care you actually need.
Drug Coverage Costs
If your Medicare Advantage plan includes prescription drug coverage, you will pay copays or coinsurance for medications based on the plan's formulary tiers. In 2026, Part D out-of-pocket drug costs are capped at $2,100 for covered drugs, meaning your annual drug spending will not exceed that amount regardless of how many prescriptions you fill. This cap was established under the Inflation Reduction Act and adjusted for inflation. Insulin costs are also capped at $35 per month per covered insulin product under Part D in 2026, according to CMS.
Medicare costs are complex, and plan details change each year. Always verify figures with your specific plan, and consult a licensed insurance agent or a free SHIP counselor before enrolling. Visiting Medicare.gov is the best starting point for official, up-to-date information on what plans are available in your area.
Estimate your real Medicare Advantage cost.
See premiums plus out-of-pocket in seconds, free and private.
Open the calculator