Medicare Advantage costs vary by plan, location, and your income — but the base premium is often $0

Medicare Advantage plans (also called Part C) are run by private insurance companies, not Medicare directly. What you pay depends on three things: the plan's monthly premium, what you pay when you use care, and whether you may have access to for subsidies that lower your costs.

Many Medicare Advantage plans charge $0 in monthly premiums — you pay only Medicare's Part B premium to stay enrolled in Original Medicare. But that does not mean care is free. You will pay copays when you see a doctor, coinsurance for hospital stays, and deductibles before coverage kicks in. The total you pay in a year is capped, which Original Medicare does not offer.

Your actual cost depends on which plan you choose, where you live, and your income. Plans in the same county can have vastly different premiums and out-of-pocket limits. Income-based subsidies can cut your costs significantly if you may have access to.

Key Takeaways

  • Many Medicare Advantage plans have $0 monthly premiums, but you still pay copays and coinsurance when you use care.
  • Your total out-of-pocket costs are capped each year — typically between $6,700 and $10,000 depending on the plan — unlike Original Medicare.
  • Plans vary by county, so two identical-sounding plans in different areas can cost completely different amounts.
  • If your income is below 200% to 300% of the federal poverty line, you may pay reduced premiums and out-of-pocket costs through the Extra Help program.
  • You can change plans once a year during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event.

The three parts of what you pay

Medicare Advantage plans charge you in three separate ways. First is the monthly premium — what you pay to the insurance company each month to stay enrolled. Many plans charge $0, but some charge $50 to $200 or more. You still pay Medicare's Part B premium ($164.90 per month in 2024, though this varies by income) no matter which plan you pick.

Second is what you pay when you use care. This includes copays (a flat fee, like $20 to see a doctor), coinsurance (a percentage of the cost, like 20%), and deductibles (an amount you pay before the plan starts paying). A plan might charge $0 to see your primary doctor but $50 to see a specialist, or $250 to stay in the hospital.

Third is your annual out-of-pocket maximum. Once you hit this limit in a calendar year, the plan pays 100% of covered services for the rest of that year. This maximum is set by Medicare and varies by plan type, but typically ranges from $6,700 to $10,000. Original Medicare has no such cap, which means your costs can grow without limit.

How premiums and out-of-pocket costs vary by location

The same insurance company offers different plans in different counties, and the costs are not the same everywhere. A plan called "Blue Cross Medicare Advantage" might cost $0 in one county and $85 per month in the next county over. Out-of-pocket limits, copays, and which doctors are included also change by location.

This happens because insurance companies set rates based on local medical costs, competition, and enrollment. A rural county with few plan options may have higher premiums than a city with ten plans competing. You cannot assume a plan you heard about from a friend in another state will cost the same or even be available where you live.

The only way to know what plans cost in your area is to enter your zip code on Medicare.gov or call 1-800-MEDICARE. Both tools show you every plan available to you, with exact premiums, copays, deductibles, and out-of-pocket maximums for your location.

Income-based subsidies that lower your costs

If your income is low enough, you may pay reduced or $0 premiums and out-of-pocket costs through a program called Extra Help (also called the Low-Income Subsidy). The income limits vary by year and family size, but generally you may have access to if your income is below 200% to 300% of the federal poverty line. For a single person in 2024, that is roughly $2,500 to $3,700 per month.

Extra Help covers your Part B premium, your plan's monthly premium, and reduces your copays and coinsurance. You do not pay the full out-of-pocket maximum — instead you pay a smaller amount, often $0 to $75 per year depending on your income level.

To learn about you may have access to, contact Social Security at 1-800-772-1213 or visit your local Social Security office. You can also call 1-800-MEDICARE and ask to be screened. If you may have access to, Social Security will enroll you in Extra Help and notify your plan. The process takes a few weeks.

What happens if you use a lot of care

Medicare Advantage plans are designed to protect you from very high costs. Once you hit your annual out-of-pocket maximum, the plan pays 100% of covered services for the rest of that year. If you have a serious illness or need surgery, you could hit that cap quickly — but after you do, you pay nothing more that year.

Original Medicare has no such cap. If you use expensive care, you could pay thousands out of pocket. Medicare Advantage trades higher copays and coinsurance for a spending limit that Original Medicare does not offer.

However, this protection only covers services the plan considers medically necessary. If you need a service the plan denies, you may have to pay the full cost or file an appeal. Plans also limit which doctors and hospitals you can use without paying extra, so using an out-of-network provider can cost more.

Prescription drug coverage and additional costs

Most Medicare Advantage plans include prescription drug coverage (Part D) built in, so you do not buy a separate drug plan. You pay a copay when you fill a prescription — typically $5 to $50 depending on the drug and the plan. Some drugs may require prior approval from the plan before the pharmacy will fill them.

A few Medicare Advantage plans do not include drug coverage. If you choose one of these, you must buy a separate Part D plan or pay the full cost of prescriptions yourself. Most people should avoid these plans unless they take very few or very inexpensive medications.

Some plans also charge extra for dental, vision, or hearing coverage. These are not covered by Original Medicare, so if you need these services, a plan that includes them can save you money. But the copays and coverage limits vary widely — a plan might cover one cleaning per year or two, and charge $0 to $50 per visit.

Costs during the first three months of enrollment

When you first join Medicare Advantage, there is a three-month trial period. During this time, you can switch to a different Medicare Advantage plan or go back to Original Medicare without penalty. This is your chance to test whether the plan works for you before you are locked in.

If you switch during the trial period, you pay only the premiums and costs for the plan you are currently in — you do not owe anything for the time you were in the first plan. After the trial period ends, you can still switch plans during the Annual Enrollment Period (October 15 to December 7 each year), but you cannot go back to Original Medicare unless you have a may have access to life event like moving out of the service area.

Frequently Asked Questions

Can I switch plans if I do not like the cost?

Yes, but only during specific times. You can switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event like moving, losing employer coverage, or becoming may be able to access for Extra Help. Outside these windows, you are locked into your plan for the year.

What if my plan raises its premium mid-year?

Plans cannot raise premiums mid-year. The premium you see when you enroll is what you pay for the entire calendar year. However, plans can change their copays, deductibles, and which doctors they include. You will receive a notice of these changes in the fall before they take effect.

Do I still pay Medicare Part B premium with Medicare Advantage?

Yes. You pay Medicare's Part B premium ($164.90 per month in 2024, adjusted for income) to Medicare, plus any additional premium the Medicare Advantage plan charges. The plan premium is separate from Part B. If you may have access to for Extra Help, it covers both.

What if I cannot afford the copays?

If you are struggling to pay copays, contact your plan's member services line and ask about hardship programs or payment plans. Some plans offer reduced copays for people with financial hardship. You can also contact your local Area Agency on Aging or a patient advocate organization for your condition — many offer copay information programs.

Are there plans with $0 premium and low copays?

Some plans offer $0 premiums with low copays, but these are usually available only in certain areas and may have narrower networks of doctors. A plan with $0 premium and $0 copay to see your primary doctor might charge $50 to see a specialist or have a $250 hospital deductible. Compare the full cost picture, not just the premium.