How Much Does Medicare Advantage Actually Cost? No Jargon

Medicare costs can feel like a maze -- premiums, deductibles, copays, coinsurance, out-of-pocket maximums. If your head is spinning, you are not alone. Let us break down exactly what Medicare Advantage costs in plain English, so you know what to expect before you choose a plan.

The premium you see advertised -- and the one you do not

You have probably seen ads for Medicare Advantage plans that say $0 premium. That part is true -- many plans really do have no additional monthly premium. But here is what those ads do not always make obvious: you still pay your Medicare Part B premium, which is automatically deducted from your Social Security check each month (about $185 per month in 2026 for most people). So a $0-premium Medicare Advantage plan is not actually free -- it just does not add an extra charge on top of what you already pay for Part B. That said, compared to keeping Original Medicare and adding a Medigap supplement (which can cost $150 to $300 per month), Medicare Advantage is often significantly cheaper.

What you pay when you actually use healthcare

Even on a $0-premium plan, you pay copays and coinsurance each time you use a medical service. A typical primary care visit might be $0 to $15. Seeing a specialist might be $35 to $50. Going to the emergency room is usually higher -- $90 to $120 on many plans, waived if you are admitted. These amounts are fixed copays, which most people find easier to budget for than the 20% coinsurance of Original Medicare.

The out-of-pocket maximum -- this is important

Here is something Original Medicare does not have that Medicare Advantage does: an annual cap on what you can owe. Once your total out-of-pocket costs reach a certain limit for the year (often between $3,500 and $8,300 for in-network care), the plan pays 100% of covered services for the rest of the year. This is a major financial protection that Original Medicare simply does not offer. Without a Medigap policy, Original Medicare's 20% coinsurance has no ceiling -- a serious illness could cost you tens of thousands of dollars.

Prescription drug costs

Most Medicare Advantage plans bundle drug coverage (Part D) into the plan. You pay a copay each time you fill a prescription, which varies by drug tier. Tier 1 generics are often $0 to $5. Preferred brand drugs might be $25 to $47. Non-preferred brands and specialty drugs can be significantly higher. Before enrolling in any plan, a licensed agent should check your specific medications against the plan's drug formulary to make sure they are covered at a cost you can afford.

Other questions we can help with

• Does Medicare Advantage Cover Dental? A Plain-English Answer
• Medicare Advantage vs. Original Medicare: Which Is Right for You?
• When Can I Sign Up for Medicare Advantage? Enrollment Periods Explained Simply
• What Extra Benefits Does Medicare Advantage Include? The Full List