Quick Answer
The average Medicare Advantage premium is $17/month in 2026, but many plans have $0 premiums. You still pay the Part B premium ($185/month). The annual out-of-pocket maximum is $9,350 for in-network care.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| MA HMO | $0–$50/month avg | Lowest premiums; requires in-network providers and referrals |
| MA PPO | $30–$100/month avg | Higher premiums; more flexibility with out-of-network providers |
| Original Medicare | $185/month (Part B) | No OOP maximum; 20% coinsurance with no cap |
| Medigap Plan G | $100–$300/month | Covers most cost-sharing; no network restrictions |
Understanding Your Coverage Options
Medicare Advantage HMO
Medicare Advantage HMO plans typically have the lowest premiums - many are $0/month. However, you must use in-network providers and generally need referrals to see specialists.
HMOs are most cost-effective when you have a primary care doctor you trust and don't need frequent specialist visits. The trade-off for low premiums is a more restricted network.
What It Covers
- Part A and B benefits (all Original Medicare services)
- Usually includes Part D drug coverage (MAPD)
- Often includes dental, vision, and hearing benefits
- Fitness benefits (SilverSneakers or similar)
What It Doesn't Cover
- Out-of-network care (except emergencies)
- Specialist visits without a referral from your PCP
Medicare Advantage PPO
PPO plans offer more flexibility - you can see out-of-network providers at a higher cost-share. No referrals are required for specialists. Premiums are typically higher than HMOs.
PPOs are a good choice if you travel frequently, have multiple specialists, or want the option to see providers outside the plan's network.
What It Covers
- In-network and out-of-network providers (at different cost-share levels)
- Specialist visits without referrals
- Part A and B benefits plus usually Part D
- Dental, vision, hearing benefits (varies by plan)
What It Doesn't Cover
- Out-of-network OOP maximum is higher (up to $14,000 in 2026)
- Some PPOs have limited out-of-network coverage in certain areas
Cost Factors that Affect Your Premium
Medicare Advantage premiums vary significantly by county. Urban areas with more competition tend to have lower premiums and more $0-premium plans. Rural areas may have fewer plan options and higher costs.
Your premium also depends on the plan's star rating, benefit richness (dental/vision/hearing), drug formulary, and whether it includes a Part B Give Back benefit.
What It Covers
- Lower premiums in competitive urban markets
- Part B Give Back benefit (reduces your Part B premium by up to $148.50/month)
- 5-star plans available year-round via Special Enrollment Period
What It Doesn't Cover
- Part B premium ($185/month) - you always pay this regardless of MA plan
- IRMAA surcharges if your income exceeds $109,000 (single)
Out-of-Pocket Maximum
Unlike Original Medicare, all Medicare Advantage plans have an annual out-of-pocket maximum. In 2026, the in-network OOP maximum is capped at $9,350 by CMS. Once you reach this limit, your plan covers 100% of covered services for the rest of the year.
PPO plans have a separate combined in-and-out-of-network OOP maximum, which can be higher. Always check both limits when comparing plans.
What It Covers
- 100% of covered services after OOP maximum is reached
- In-network OOP max capped at $9,350 by CMS
- Catastrophic protection not available in Original Medicare alone
What It Doesn't Cover
- Part B premium does not count toward the OOP maximum
- Out-of-network costs may have a separate, higher OOP maximum
2026 Medicare Advantage Cost Comparison
| Plan Type | Avg Monthly Premium | Part B Premium | Deductible | OOP Max (In-Network) | Dental/Vision |
|---|---|---|---|---|---|
| MA HMO ($0 premium) | $0 | $185 | $0–$500 | $3,500–$7,500 | Often included |
| MA PPO | $30–$100 | $185 | $0–$500 | $5,000–$9,350 | Often included |
| MA with Part B Giveback | $0 | $185 minus giveback | Varies | Varies | Varies |
| Original Medicare only | $0 | $185 | $257 (Part B) | No cap | Not covered |
| Original Medicare + Medigap G | $100–$300 | $185 | $257 (Part B only) | Near $0 after deductible | Not covered |
✦ Important Cost Considerations
You Always Pay the Part B Premium
Even with a $0-premium Medicare Advantage plan, you still pay the Medicare Part B premium ($185/month in 2026). Some MA plans offer a Part B Give Back benefit that reduces this amount.
A '$0 premium' MA plan does not mean $0 total cost - you still pay Part B ($185/month).
IRMAA Surcharges Apply
If your income exceeds $109,000 (single) or $218,000 (joint), you pay an IRMAA surcharge on top of the Part B premium. This applies regardless of whether you have Original Medicare or Medicare Advantage.
High-income beneficiaries pay an IRMAA surcharge ranging from $81.20 to $487.00/month on top of the base Part B premium.
Extra Benefits Vary by Plan
Dental, vision, hearing, fitness, and over-the-counter allowances vary widely by plan. CMS has increased scrutiny of extra benefits in 2026, and some plans have reduced or eliminated benefits that were previously offered.
Always verify extra benefits for the upcoming year during Annual Enrollment Period (Oct 15 – Dec 7).
✦ Legislative Update
2026 MA OOP Maximum Stays at $9,350
PassedCMS kept the in-network out-of-pocket maximum at $9,350 for 2026. The combined in-and-out-of-network maximum for PPO plans is $14,000.
MA Extra Benefit Scrutiny
PassedCMS increased oversight of supplemental benefits in 2026, requiring plans to demonstrate that extra benefits are primarily health-related. Some plans reduced dental/vision/OTC allowances as a result.
Part B Premium Increased to $185
PassedThe standard Part B premium increased to $185/month in 2026, up from $174.70 in 2025. This affects all Medicare beneficiaries, including those with MA plans.
How to Find the Best Medicare Advantage Plan for Your Budget
The best Medicare Advantage plan isn't always the one with the lowest premium. Consider total out-of-pocket costs including copays, coinsurance, and the OOP maximum.
Use Medicare's Plan Finder tool at Medicare.gov to compare plans in your ZIP code during Annual Enrollment Period (October 15 – December 7).
MA Plan Shopping Checklist
- Compare total costs, not just premiums (include copays and OOP max)
- Verify your doctors and specialists are in-network
- Check if your prescriptions are on the formulary
- Compare dental, vision, and hearing benefits
- Look for Part B Give Back plans in your area
- Check the plan's star rating (4+ stars = higher quality)
- Review the Evidence of Coverage for prior authorization requirements
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert who has been helping beneficiaries navigate their Medicare options for over a decade.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent dedicated to helping those eligible for Medicare find the best coverage options.