Medicare Advantage costs vary by plan and location, but most people pay a monthly premium between $0 and $200, plus copays when you use care

Your total cost for a Medicare Advantage plan has three parts: the monthly premium you send to the insurance company, the copays or coinsurance you pay at the doctor's office or hospital, and any out-of-pocket maximum you might hit in a given year. The monthly premium is what appears on your bill. The copays are what you pay per visit. The out-of-pocket maximum is the most you will spend on copays and coinsurance in a calendar year — after you hit that number, the plan covers the rest.

Because Medicare Advantage plans are sold by private insurers and vary widely, the same plan costs different amounts in different counties. A plan that costs $15 a month in one part of your state might cost $85 in another. The only way to know what a specific plan costs in your zip code is to look it up during the annual enrollment period (October 15 to December 7 each year) on Medicare.gov or through your state health insurance counselor.

Key Takeaways

  • Most Medicare Advantage plans charge a monthly premium between $0 and $200, but the exact amount depends on your county and the plan you choose.
  • You will also pay copays at the doctor or hospital — typically $10 to $50 per visit — which are separate from the monthly premium.
  • Every Medicare Advantage plan has an out-of-pocket maximum, usually between $3,000 and $7,000 per year, which is the most you will spend on copays and coinsurance combined.
  • Plans with lower monthly premiums often have higher copays, and plans with higher premiums often have lower copays — you choose which trade-off works for your budget.
  • You must have Part A and Part B to join a Medicare Advantage plan, and you continue to pay the Part B premium to Medicare even if your plan premium is $0.

The three parts of what you pay

The monthly premium is the amount you pay the insurance company each month to keep the plan active. This is separate from your Part B premium, which you pay to Medicare. If a plan shows a $0 premium, you still pay your Part B premium to Medicare — the $0 refers only to the plan's own charge. Premiums are set by the insurance company and approved by Medicare, and they can change each year.

Copays are fixed amounts you pay for specific services. A plan might charge $10 for a primary care visit, $40 for a specialist visit, $250 for an emergency room visit, or $300 per day for a hospital stay (up to a limit). These amounts vary by plan. Some plans charge coinsurance instead of copays — that means you pay a percentage of the cost (like 20%) rather than a flat fee. Copays and coinsurance are what you pay at the time of service, in addition to your monthly premium.

The out-of-pocket maximum is a yearly limit on how much you will spend on copays and coinsurance combined. Once you reach this number in a calendar year, the plan covers 100% of covered services for the rest of that year. Most Medicare Advantage plans set this between $3,000 and $7,000 per year. This limit does not include your monthly premium — you pay that regardless of whether you hit the maximum.

How premiums differ by plan and location

The same insurance company often offers multiple Medicare Advantage plans in the same county, and they charge different premiums. A plan with a $0 premium might have higher copays than a plan with a $100 premium. A plan that covers dental and vision might cost more than one that does not. You are choosing the combination of premium, copays, and covered services that fits your situation.

Location matters more than most people expect. Medicare Advantage plans are priced based on the cost of medical care in your area. If you live in a county where hospital stays and specialist visits are expensive, plans in that county will charge higher premiums or copays to cover those costs. If you move to a different county, even within the same state, the same plan might not be available, or it might cost significantly more or less.

During the annual enrollment period, you can compare all available plans in your zip code side by side. Medicare.gov has a plan comparison tool that shows the premium, copays, deductibles, and out-of-pocket maximum for each plan. Your state health insurance counselor (find yours through the State Health Insurance information Program, or SHIP) can walk you through the comparison at no cost.

What happens if you use a lot of care

If you have chronic conditions or expect to use medical services frequently, the out-of-pocket maximum becomes important. Let's say you choose a plan with a $0 premium and $40 copays for specialist visits. If you see a specialist 10 times in a year, you pay $400 in copays. If you see a specialist 100 times, you pay copays until you hit the out-of-pocket maximum — then the plan covers the rest.

A plan with a higher monthly premium but lower copays might cost you less overall if you use a lot of care. A plan with a $100 monthly premium ($1,200 per year) and $10 copays might cost less than a $0 premium plan with $50 copays if you have frequent doctor visits. The math depends on how much care you actually use, which is why comparing plans side by side matters.

If you are unsure how much care you will need, look at what you used in the past year. How many times did you see a doctor? How many specialist visits? Did you have any hospital stays? Use that pattern to estimate your costs under each plan you are considering.

Extra benefits and what they cost

Many Medicare Advantage plans include benefits that Original Medicare does not cover, such as dental, vision, hearing aids, or fitness programs. These extra benefits are often included in plans with $0 or low premiums. However, the copays for these services vary. A plan might cover dental cleanings with no copay but charge $50 for a filling. Another plan might charge a copay for the cleaning but cover fillings at no cost.

If you use these services regularly, factor them into your comparison. If you do not use dental care, a plan with dental coverage might not be worth paying a higher premium. If you wear hearing aids and need them replaced every few years, a plan that covers hearing aids might save you money even if the premium is higher.

Costs you do not pay

Medicare Advantage plans must cover all the services that Original Medicare covers, including hospital care, doctor visits, and preventive care. You do not pay a separate deductible for most of these services — you pay the copay listed in your plan. Some plans do have a deductible (usually $0 to $500 per year), which you pay before copays begin. This is different from Original Medicare, which has separate deductibles for Part A and Part B.

Preventive services — like annual wellness visits, cancer screenings, and vaccinations — are covered at no cost under Medicare Advantage, just as they are under Original Medicare. You do not pay a copay for these visits if they are classified as preventive. If your doctor decides during a preventive visit that you need additional testing or treatment, that additional service might have a copay.

How to find the actual cost for your situation

The only way to know what a plan costs in your area is to look it up during the annual enrollment period. Go to Medicare.gov and enter your zip code. The site will show every Medicare Advantage plan available to you, with the premium, copays, deductible, and out-of-pocket maximum for each one. You can also call 1-800-MEDICARE to speak with someone who can help you compare.

Your state SHIP counselor can also help you compare plans. SHIP is a free service funded by Medicare, and counselors have no incentive to steer you toward any particular plan. To find your state's SHIP, search online for "[your state] SHIP" or call 1-800-MEDICARE and ask for the referral.

If you are already in a Medicare Advantage plan, you receive a notice each fall showing what your plan will cost next year. If the premium, copays, or out-of-pocket maximum increase significantly, that is a signal to compare other plans during the enrollment period. You can switch plans once per year, during the annual enrollment period from October 15 to December 7.

Frequently Asked Questions

Do I have to pay my Part B premium if my Medicare Advantage plan premium is $0?

Yes. Your Part B premium goes to Medicare, not to the insurance company. A $0 plan premium means the insurance company charges nothing, but you still owe Medicare for Part B. Most people have Part B premiums automatically deducted from their Social Security check.

What is the difference between a copay and coinsurance?

A copay is a fixed amount you pay for a service — for example, $40 for a doctor visit. Coinsurance is a percentage of the cost — for example, you pay 20% and the plan pays 80%. Some plans use copays, some use coinsurance, and some use both for different services.

Can my copays increase during the year?

No. The copays in your plan are set for the calendar year. They can change on January 1 of the next year, but not in the middle of the year. If your plan changes its copays, you will receive notice before the change takes effect.

What happens to my out-of-pocket maximum if I switch plans mid-year?

You cannot switch Medicare Advantage plans mid-year except during the annual enrollment period or if you have a may have access to life event (like moving to a new county or losing other coverage). If you do switch, your out-of-pocket spending from the old plan does not carry over — you start fresh with the new plan's maximum.

Are there plans with no premium and no copays?

No. All Medicare Advantage plans charge either a premium or copays, or both. Some plans have $0 premiums but charge copays. Some have low premiums and low copays. You will always pay something when you use care, either upfront as a premium or at the time of service as a copay.