Medicare Advantage plans have no single price because costs depend on which plan you choose, where you live, and what your income is

Medicare Advantage (also called Part C) replaces Original Medicare with coverage from a private insurance company. The monthly premium you pay varies widely — some plans cost nothing per month, while others charge $200 or more. Your actual out-of-pocket costs also depend on deductibles, copays for doctor visits, and how much you use care during the year.

The base premium is only part of what you pay. You still pay the Part B premium to Medicare (the amount deducted from your Social Security check or paid directly). On top of that, your plan may charge its own monthly premium, and you will have copays and deductibles when you use services. Some plans also charge extra for dental, vision, or hearing coverage that Original Medicare does not include.

Key Takeaways

  • Many Medicare Advantage plans charge zero monthly premium beyond what you already pay Medicare for Part B, but you still pay copays and deductibles when you use care.
  • Plans with lower or no premiums often have higher copays and deductibles, while plans with higher premiums may have lower costs when you use services.
  • Your actual cost depends on which doctors and hospitals are in the plan's network and how much care you use in a given year.
  • Income-based subsidies can lower your premium and out-of-pocket costs if you may have access to, and the rules change each year.

How premiums are set and what they cover

Insurance companies set their own premiums for Medicare Advantage plans, and Medicare approves them each year. A plan available in your county may cost nothing per month, $50 per month, or more — even if both plans cover the same services. The premium you see advertised is what the plan charges on top of your Part B premium, which you pay to Medicare no matter which plan you choose.

The premium covers the plan's administrative costs and profit margin, but it does not cover all your care. When you see a doctor, fill a prescription, or go to the hospital, you pay a copay (a flat fee like $25 for a visit) or coinsurance (a percentage of the cost). You also pay a deductible — the amount you must pay out of pocket before the plan starts sharing costs — though some plans have no deductible.

Plans with zero or low premiums typically have higher copays and deductibles. Plans with higher premiums often have lower copays and deductibles. Neither is automatically better; it depends on how much care you expect to use.

Out-of-pocket costs beyond the monthly premium

Your deductible is what you pay before the plan covers anything. Medicare Advantage plans can have deductibles ranging from zero to several hundred dollars per year, and the deductible may be different for different types of care (one for doctor visits, another for hospital stays). Once you meet the deductible, you pay a copay for each visit or service.

A typical copay structure might be $25 for a primary care visit, $50 for a specialist, and $250 for a hospital admission. Prescription drugs have their own copays, which vary by tier — generic drugs cost less than brand-name drugs. Preventive services like annual wellness visits and cancer screenings are usually free, even before you meet your deductible.

Medicare Advantage plans have an out-of-pocket maximum, which is the most you will pay in a year for covered services. Once you reach that limit, the plan covers 100% of covered care for the rest of the year. The maximum varies by plan but is capped by Medicare at a certain amount each year (the limit changes annually).

Network restrictions and how they affect your choices

Medicare Advantage plans use networks — lists of doctors, hospitals, and pharmacies that have agreed to work with the plan. You must use in-network providers to get the plan's advertised copay rates. If you see an out-of-network doctor, you pay more, sometimes much more, or the plan may not cover the visit at all.

Some plans are Health Maintenance Organizations (HMOs), which require you to pick a primary care doctor and get referrals to see specialists. Others are Preferred Provider Organizations (PPOs), which let you see specialists without a referral and may cover some out-of-network care at a higher cost. A few plans are Point of Service (POS) plans, which combine features of both.

Before you choose a plan based on premium alone, check whether your current doctors are in the network. A plan with a zero premium is not a bargain if your doctor does not participate and you have to switch.

Extra benefits and what they cost

Many Medicare Advantage plans include benefits that Original Medicare does not: dental coverage (cleanings, fillings, sometimes dentures), vision coverage (eye exams, glasses or contacts), and hearing coverage (exams and hearing aids). Some plans also cover fitness programs, transportation to medical appointments, or over-the-counter drug allowances.

These extras are often advertised as "free," but they are built into the plan's structure and premium. A plan that includes dental coverage may have a higher premium than one that does not, or the dental benefits may have their own limits and copays. For example, a plan might cover two cleanings per year but charge a copay for each one, or cover basic fillings but not crowns.

Read the plan's Summary of Benefits to see exactly what is covered, what the copays are, and what the annual limits are. Do not assume that because a benefit is listed, it is free or unlimited.

Income-based cost reductions

If your income is below a certain level, you may may have access to for Extra Help (also called the Low-Income Subsidy), which reduces your Part D prescription drug costs. You may also may have access to for Medicare Savings Programs, which help pay your Part B premium and other out-of-pocket costs. These programs are run by your state, and income limits vary by state and change each year.

To learn about you may have access to, contact your state Medicaid office or call 1-800-MEDICARE. You can also explore through the Social Security Administration website. If you may have access to, the subsidy is applied automatically when you enroll in a plan, and it reduces what you pay each month and when you use services.

Retirees with pensions or savings above the income limit may not may have access to, but it is worth checking because the rules are complex and limits are higher than many people expect.

How to compare costs between plans

Medicare provides a tool called Medicare Plan Finder on Medicare.gov where you can enter your zip code, current doctors, and medications to see plans available to you and their costs side by side. The tool shows the monthly premium, deductible, copays for common services, and whether your doctors are in the network.

When you compare plans, look at the total estimated cost for a year, not just the premium. If you take several medications, add up the copays for each one under each plan. If you see a specialist regularly, multiply the specialist copay by how many visits you expect. A plan with a higher premium but lower copays may cost less overall if you use a lot of care.

You can also call plans directly to ask about costs for specific services. Plans are required to answer questions about their benefits and costs, and representatives can walk you through what you would pay for your situation.

When costs change and what to do about it

Medicare Advantage plans change their premiums, copays, deductibles, and networks every year. A plan you chose last year may cost more this year, cover fewer doctors, or have higher copays. Medicare sends you a notice in the fall listing changes to your current plan, and you have a window to switch to a different plan without penalty.

Open Enrollment runs from October 15 to December 7 each year. During this time, you can switch to a different Medicare Advantage plan, switch to Original Medicare, or switch from Original Medicare to Medicare Advantage. Changes take effect on January 1. If you do not make a change, you stay in your current plan with its new costs.

Mark your calendar to review your plan's costs and coverage each October. Even if you liked your plan last year, the changes this year might make a different plan a better fit for your health and budget.

Frequently Asked Questions

Do I have to pay a monthly premium for Medicare Advantage?

Not always. Many plans charge zero monthly premium beyond your Part B premium to Medicare. However, you still pay copays and deductibles when you use care. Plans with no premium often have higher copays, so your total cost depends on how much care you use.

What is the difference between a copay and coinsurance?

A copay is a flat fee you pay for a service, like $25 for a doctor visit. Coinsurance is a percentage of the cost you pay after meeting your deductible, like 20% of a hospital bill. Your plan documents will specify which services use copays and which use coinsurance.

Can I use any doctor with Medicare Advantage?

Only doctors in your plan's network. If you see an out-of-network doctor, you pay more or the plan may not cover it at all. Before you choose a plan, check whether your current doctors participate. You can search the plan's website or call the plan to verify.

What happens if I reach my out-of-pocket maximum?

Once you pay the maximum amount in copays and coinsurance for the year, the plan covers 100% of your covered care for the rest of that calendar year. The maximum resets on January 1. Your plan documents show what the maximum is for your plan.

Can I switch plans if my costs go up?

Yes, during Open Enrollment from October 15 to December 7 each year. You can switch to a different Medicare Advantage plan, switch to Original Medicare, or make other changes. Any changes take effect on January 1. Outside of Open Enrollment, you can only switch if you have a may have access to life event like moving or losing other coverage.