Overview of Medicare Advantage Costs
Medicare Advantage plans have a different cost structure than Original Medicare. While many plans advertise $0 monthly premiums, you still pay your Medicare Part B premium ($202.90/month in 2026 for most people). Total costs depend on the plan type, your health needs, and how often you use healthcare services.
Cost Components
| Cost Type | Description | 2025 Range |
|---|---|---|
| Monthly premium | Amount paid each month for the plan (in addition to Part B premium) | $0 – $200+ |
| Annual deductible | Amount you pay before the plan starts covering costs | $0 – $600 |
| Copays | Fixed amount per visit or service | $0 – $50 (PCP); $0 – $100+ (specialist) |
| Coinsurance | Percentage of costs you pay after deductible | 0% – 50% |
| Out-of-pocket maximum | Annual cap on your costs (in-network) | Up to $9,350 (2025) |
Out-of-Pocket Maximum
One of the most important features of Medicare Advantage is the out-of-pocket maximum - a cap on how much you'll spend in a year. Once you reach this limit, the plan pays 100% of covered in-network costs for the rest of the year.
In 2025, the maximum allowed out-of-pocket limit for in-network services is $9,350. Many plans set their limits lower. Some plans also have a combined in/out-of-network limit, which can be higher.
Original Medicare has no out-of-pocket maximum without a Medigap supplement plan.
Extra Benefits and Their Costs
Many Medicare Advantage plans include extra benefits not covered by Original Medicare. These are often included at no additional cost:
- Dental - Routine cleanings, X-rays, and sometimes major dental work
- Vision - Eye exams and an allowance for glasses or contacts
- Hearing - Hearing exams and an allowance for hearing aids
- Fitness - Gym memberships or fitness programs (SilverSneakers, etc.)
- Transportation - Rides to medical appointments
- Over-the-counter allowance - Quarterly credit for OTC health products