Medicare Part C premiums vary by plan and location, not by a set federal amount

Medicare Part C, also called Medicare Advantage, does not have a single monthly cost. Instead, each insurance company that offers a Part C plan sets its own premium. Some plans charge zero dollars per month in premium — you pay only the standard Medicare Part B premium (which changes yearly) plus any out-of-pocket costs when you use care. Other plans charge $50, $100, or more per month on top of Part B. The premium you pay depends entirely on which plan you choose and where you live.

The monthly cost you see advertised for a specific plan is what the insurance company charges above the Part B premium you already pay to Medicare. So your total monthly cost is Part B plus the plan's premium, plus anything you spend on copays, coinsurance, or deductibles when you receive care.

Key Takeaways

  • Medicare Part C premiums are set by each insurance company and range from $0 to over $100 per month, depending on the plan and your location.
  • You always pay the standard Medicare Part B premium to Medicare, then pay the Part C plan's additional premium to the insurance company.
  • Plans with $0 premium often have higher out-of-pocket costs (copays and deductibles) than plans with higher premiums.
  • Your actual monthly cost also includes copays and coinsurance when you see doctors, fill prescriptions, or use other services.
  • Premiums and plan details change every year, so you should review your options during the annual enrollment period (October 15 to December 7).

How Part C premiums are structured

When you enroll in a Medicare Part C plan, you are buying coverage from a private insurance company, not directly from Medicare. That company decides what to charge you each month. Medicare pays the insurance company a set amount for each person enrolled, but the company can charge you more or less than that amount — or nothing at all.

A plan with a $0 monthly premium means the insurance company's payment from Medicare covers its costs for that plan in your area. A plan with a $50 or $100 monthly premium means the company is charging you extra. Neither approach is better or worse on its own — a $0 premium plan might have a $300 deductible and $50 copays, while a $100 premium plan might have a $0 deductible and $15 copays. You have to look at the full cost picture, not just the premium.

What affects the premium you pay

Your location is the biggest factor. An insurance company might offer a $0 premium plan in one county and a $75 premium plan in the next county over. Healthcare costs, doctor availability, and competition between insurers all vary by region, and premiums reflect those differences.

The type of plan also matters. Health Maintenance Organization (HMO) plans often have lower or $0 premiums but require you to use doctors in their network. Preferred Provider Organization (PPO) plans usually charge higher premiums but let you see doctors outside the network. Special needs plans (SNPs) designed for people with specific conditions may have different premium structures.

Your age and health status do not affect the premium — Medicare Part C plans cannot charge you more because you are older or have a chronic illness. However, if you enroll late (after your initial enrollment window), you may pay a permanent penalty on top of the plan's regular premium.

The difference between premium and total cost

Premium is only one piece of what you pay. When you go to the doctor, you typically pay a copay (a flat fee like $15 or $40). When you fill a prescription, you pay a copay or coinsurance (a percentage of the cost). If you need hospital care or surgery, you might pay a deductible first, then coinsurance for the rest.

A plan with a $0 premium might have a $250 annual deductible and $50 copays for specialist visits. A plan with a $100 monthly premium ($1,200 per year) might have a $0 deductible and $15 copays. If you see a specialist once a year, the $0 premium plan costs you $250 plus $50 = $300 total. The $100 premium plan costs you $1,200 plus $15 = $1,215 total. The math changes if you see specialists more often or need hospital care.

How to find the actual premium for plans in your area

The Medicare Plan Finder tool on Medicare.gov lets you enter your zip code and see every Part C plan available to you, along with the exact monthly premium for each one. You can also see the deductibles, copays, and which doctors and pharmacies are in each plan's network.

Insurance brokers and counselors through your State Health Insurance information Program (SHIP) can also walk you through plans and their costs. SHIP is free and has no sales incentive — the counselor is not paid by any insurance company. You can find your state's SHIP by calling 1-800-MEDICARE or visiting Medicare.gov.

When premiums change

Every January 1, Medicare Part C plans can change their premiums, deductibles, copays, and networks. An insurance company might offer a $0 premium plan one year and charge $50 the next year. A plan you like might disappear entirely. A doctor you see might leave the network.

This is why the annual enrollment period (October 15 to December 7 each year) matters. During this window, you can switch to a different Part C plan, switch to Original Medicare, or make other changes to your coverage. Outside this window, you generally cannot change plans unless you have a may have access to life event (like moving to a new state or losing other coverage).

Part B premium: the cost you pay no matter what

Regardless of which Part C plan you choose, you pay the standard Medicare Part B premium to Medicare each month. In 2024, the standard Part B premium is $164.90 per month, but this amount changes yearly. If your income is higher, you may pay more — Medicare uses a sliding scale for people earning over a certain threshold.

Your Part C plan's premium is added to this Part B premium. So if you choose a plan with a $50 monthly premium, your total premium payment is $164.90 (Part B) plus $50 (Part C) = $214.90 per month, before any copays or other out-of-pocket costs.

Frequently Asked Questions

Can I switch Part C plans if the premium goes up?

Yes, during the annual enrollment period from October 15 to December 7, you can switch to any other Part C plan available in your area, or switch back to Original Medicare. If you switch plans, your new coverage starts January 1. Outside this window, you cannot switch unless you have a may have access to event like moving or losing other coverage.

Do I pay Part C premium if I'm still working and have employer coverage?

If you are enrolled in a Part C plan, you pay the plan's premium whether or not you have employer coverage. However, if you have employer coverage, you might not need Part C at all — talk to your employer's benefits team and a Medicare counselor before enrolling in Part C to understand how the two interact.

What if I can't afford the Part C premium?

If your income is low, you may be able to get help paying premiums through Medicare Savings Programs or Low-Income Subsidy (LIS) programs. These are run by your state. Call 1-800-MEDICARE or contact your state Medicaid office to learn whether you may be may be able to access for cost information.

Does the Part C premium include prescription drug coverage?

Most Part C plans include prescription drug coverage (Part D) as part of the plan. The premium you see usually covers both medical and drug benefits. However, some plans do not include drug coverage, so check the plan details before enrolling. If your plan does not include drugs, you must enroll in a separate Part D plan.

Why do two plans in my area have different premiums if they're both offered by the same company?

The same insurance company often offers multiple Part C plans with different networks, benefits, and premiums. One might be an HMO with a $0 premium and a smaller network. Another might be a PPO with a $75 premium and a larger network. You choose based on which plan's benefits and network fit your needs and budget.