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

Medicare Advantage (also called Part C) is an alternative to Original Medicare run by private insurance companies approved by Medicare. The total cost depends on three things: the monthly premium you pay the insurance company, the copays and coinsurance you pay when you see a doctor or get treatment, and whether you use services that cost extra.

Some Medicare Advantage plans have no monthly premium at all — you pay only Medicare's Part B premium to the government, then copays to the plan when you use care. Others charge $50 to $200 per month on top of that. The trade-off is usually that plans with lower or no premiums have higher copays, while plans with higher premiums often have lower copays.

Unlike Original Medicare, Medicare Advantage plans have an annual out-of-pocket limit — the most you will pay in copays and coinsurance in a year. Once you hit that limit, the plan covers the rest of your care at no cost. Original Medicare has no such limit. In 2024, that out-of-pocket maximum ranges from about $4,500 to $7,550 depending on the plan, but this amount changes each year.

Key Takeaways

  • Medicare Advantage premiums range from $0 to $200 per month, and you still pay Medicare's Part B premium to the government regardless of which plan you choose.
  • You pay copays when you use doctors, hospitals, or other services — the amount depends on your specific plan and the type of care.
  • Every Medicare Advantage plan has an annual out-of-pocket limit, meaning your copays and coinsurance stop once you reach that cap for the year.
  • Prescription drug coverage is included in most Medicare Advantage plans, unlike Original Medicare, which requires a separate Part D plan.
  • The cost of the same plan type varies by county and ZIP code, so two identical plan names can have different premiums in different areas.

How premiums, copays, and out-of-pocket limits work together

Think of Medicare Advantage cost in three layers. The first layer is the monthly premium — what you pay just to have the plan, whether you use it or not. The second layer is copays and coinsurance — what you pay each time you see a doctor, fill a prescription, or go to the hospital. The third layer is the annual out-of-pocket limit, which stops you from paying more than a certain amount in a year.

A plan with a $0 premium might charge you $45 to see your primary care doctor, $150 for a specialist visit, and $300 for an emergency room visit. A plan with a $150 monthly premium might charge you $15 to see your primary care doctor, $40 for a specialist, and $100 for the emergency room. If you rarely see doctors, the $0 premium plan costs less overall. If you have chronic conditions and see doctors frequently, the higher-premium plan might save you money because your copays are lower.

The out-of-pocket limit is a safety net. If you have a serious illness or injury and rack up $8,000 in copays and coinsurance, but your plan's out-of-pocket limit is $7,000, the plan covers the remaining $1,000. This limit resets on January 1 each year.

What is included and what costs extra

Most Medicare Advantage plans include prescription drug coverage (Part D), dental, vision, and hearing benefits — things Original Medicare does not cover. Some plans also include gym memberships, meal delivery, or transportation to medical appointments. These extras are why some people choose Medicare Advantage even when the copays are higher.

However, not every service is covered the same way. If you need a specialist, you may have to get a referral from your primary care doctor first, or the copay will be higher. If you need an MRI or surgery, the plan may require prior authorization — meaning the doctor has to get permission from the insurance company before the procedure, or you pay more out of pocket. Some plans cover certain medications only if you try a cheaper drug first.

Out-of-network care — seeing a doctor who does not have a contract with your plan — usually costs more or may not be covered at all, except in emergencies. This is different from Original Medicare, which covers any doctor who accepts Medicare, anywhere in the country.

How location affects what you pay

The same Medicare Advantage plan can cost different amounts in different parts of your state or country. A UnitedHealthcare Medicare Advantage plan in one county might have a $0 premium and $40 doctor copays, while the same plan name in a neighboring county might have a $75 premium and $30 doctor copays. Insurance companies set premiums based on local healthcare costs and competition in each area.

This means you cannot compare plans by name alone. You have to look at the plans available in your specific ZIP code. The Medicare Plan Finder tool on Medicare.gov lets you enter your address and see all the plans available to you, along with their exact premiums and copays.

Comparing Medicare Advantage to Original Medicare costs

Original Medicare (Part A and Part B) has no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. Part B costs about $165 per month in 2024 for most people, though higher earners pay more. You also pay a copay or coinsurance for each service — usually 20% of the cost after you meet your deductible.

Original Medicare has no out-of-pocket limit, so if you have a serious illness, your costs can be very high. Many people on Original Medicare buy a Medigap (supplemental insurance) plan to cover the gaps, which adds another $100 to $300 per month depending on the plan and your age.

Medicare Advantage typically costs less per month if you are healthy and do not see many doctors. But if you have multiple chronic conditions or expect high medical costs, the out-of-pocket limit in Medicare Advantage can protect you from very large bills. The right choice depends on your health, your budget, and how much predictability you want in your costs.

When costs change and how to prepare

Medicare Advantage plans change their premiums and copays every year, usually starting January 1. Insurance companies announce changes in the fall, and you get a notice in the mail explaining what is different. Some plans may disappear entirely from your area, or new plans may become available.

You have a chance to switch plans during the Annual Enrollment Period, which runs from October 15 to December 7 each year. If your current plan's costs are going up or your health needs have changed, this is when you can move to a different plan without penalty. If you do not make a change during this window, you stay in your current plan for the next year.

It is worth reviewing your plan options every year, even if you are happy with your current plan. A new plan in your area might offer lower copays or better coverage for the medications or doctors you use most.

Frequently Asked Questions

Do I still pay Medicare Part B premium if I have Medicare Advantage?

Yes. You pay Medicare Part B premium to the government no matter which type of Medicare you choose. Medicare Advantage premiums are on top of that, not instead of it. Some Medicare Advantage plans have $0 additional premium, meaning you pay only the Part B premium.

What happens if I go to an out-of-network doctor?

Most Medicare Advantage plans do not cover out-of-network care except in emergencies. If you see an out-of-network doctor for a non-emergency, you may have to pay the full cost yourself. Some plans offer limited out-of-network coverage at a higher copay. Check your plan's details before seeing a doctor outside the network.

Can my copays change during the year?

No. Your copays, premiums, and out-of-pocket limit are set for the calendar year and do not change until January 1. However, if you switch to a different plan during the Annual Enrollment Period, your new copays take effect January 1.

What if I cannot afford the copays?

Some people with low income and limited resources may be may be able to access for programs like the Medicare Savings Program or Extra Help with prescription drugs, which can reduce your copays and premiums. Contact your local Medicaid office or call 1-800-MEDICARE to learn whether you may be may be able to access.

Is prescription drug coverage always included in Medicare Advantage?

Most Medicare Advantage plans include prescription drug coverage, but not all. Some plans are Part C only and do not include drugs. If you choose a plan without drug coverage, you must enroll in a separate Part D plan or pay a penalty if you go without coverage. Always check whether your plan includes drug coverage before you enroll.