Most Medicare Advantage plans charge $0 in monthly plan premiums, but that’s not the full picture. You still owe the standard Medicare Part B premium ($185 per month in 2025, rising to $202.90 in 2026), and you’ll face copayments, coinsurance, and deductibles when you use services. Your total annual cost depends on how much care you actually need.
The Monthly Premium You Always Pay
Every Medicare Advantage enrollee must continue paying the Part B premium, regardless of which plan they choose. In 2025 that’s $185 per month, and it increases to $202.90 in 2026. This is non-negotiable: if you stop paying it, you lose your Medicare Advantage coverage entirely.
On top of Part B, some Medicare Advantage plans charge their own monthly premium. Many popular plans set this at $0, which is a major selling point. Others charge anywhere from $10 to over $100 per month, typically in exchange for richer benefits like lower copays, broader provider networks, or more generous drug coverage. So your baseline monthly cost ranges from $185 (with a $0-premium plan in 2025) to $300 or more if you pick a plan with its own premium.
Higher Costs for Higher Earners
If your income exceeds certain thresholds, Medicare adds a surcharge called IRMAA (Income-Related Monthly Adjustment Amount) to both your Part B and prescription drug premiums. This is based on your tax return from two years prior.
For single filers in 2026, the surcharges kick in at $109,000 in annual income. At that first bracket (up to $137,000), your Part B premium jumps from $202.90 to $284.10 per month, and you pay an extra $14.50 on top of any drug plan premium. The surcharges escalate from there. At incomes above $500,000 for single filers (or $750,000 for married couples filing jointly), the Part B premium reaches $689.90 per month, with an additional $91 added to drug coverage. Most Medicare Advantage enrollees don’t hit these thresholds, but if you do, the extra cost is significant.
What You Pay When You Use Services
The day-to-day costs of Medicare Advantage come through copayments and coinsurance each time you visit a doctor, fill a prescription, or go to the hospital. These vary widely by plan, but here’s what to expect in general terms.
Primary care visits typically carry a copay in the $0 to $20 range. Specialist visits run higher, often $20 to $50. Emergency room visits have their own copayment, though if you’re admitted to the hospital within three days for a related condition, the ER copay is waived because Medicare treats it as part of your inpatient stay. Hospital stays usually involve a daily copay for a set number of days, then $0 after that, up to a coverage limit.
Every Medicare Advantage plan is required to set a maximum out-of-pocket limit for in-network services. Once you hit that cap in a calendar year, the plan covers 100% of your covered services for the rest of the year. These caps vary by plan but can run up to several thousand dollars. Choosing a plan with a lower cap gives you more financial protection if you end up needing expensive care.
Prescription Drug Costs
Most Medicare Advantage plans bundle prescription drug coverage, which means you don’t need a separate Part D plan. Drug costs are organized into tiers. Generic drugs sit on the lowest tier with the smallest copays, often just a few dollars. Preferred brand-name drugs cost more, non-preferred brands cost more still, and specialty medications (for conditions like cancer or rheumatoid arthritis) carry the highest cost-sharing.
Each plan builds its own drug list and sets its own copay amounts per tier, so two plans in the same zip code can charge very different amounts for the same medication. If you take ongoing prescriptions, the single most useful thing you can do during enrollment is plug your specific drugs into Medicare’s plan finder tool to see what each plan would actually charge you.
One cost that catches people off guard: the Part D late enrollment penalty. If you go 63 or more consecutive days without creditable drug coverage after you’re first eligible, Medicare adds a permanent surcharge to your premium. It’s calculated at 1% of the national base premium ($38.99 in 2026) for every full month you went uncovered. Twelve months without coverage, for example, would add roughly $4.70 per month to your premium for life, and that amount adjusts upward as the base premium rises each year.
Dental, Vision, and Hearing Costs
One of the biggest reasons people choose Medicare Advantage over Original Medicare is the extra benefits: dental, vision, and hearing coverage that Original Medicare largely doesn’t offer. These benefits are included in most plans, but what “included” means in practice varies quite a bit.
For vision, most enrollees get a good deal. About 71% of Medicare Advantage enrollees pay nothing for eye exams, and roughly two-thirds pay no cost-sharing for glasses or contacts. The catch is that every plan caps how much it will spend on eyewear per year, so if you need expensive progressive lenses or want designer frames, you’ll likely pay the difference out of pocket.
Hearing exams are similarly well-covered: 74% of enrollees are in plans with no cost-sharing for the exam itself. Hearing aids are another story. About 60% of enrollees face cost-sharing for hearing aids, and those costs can range from as little as $5 to as much as $3,355. If you’re considering hearing aids, check the plan’s specific benefit schedule carefully.
Dental is where the gaps tend to be widest. Preventive care like cleanings is often covered at low or no cost, but more involved work like fillings, extractions, and root canals commonly carries 50% coinsurance, meaning you pay half the bill. About 10% of Medicare Advantage enrollees must pay a separate premium just to access dental benefits at all. And many plans cap total annual dental spending at $1,000 to $2,000, which won’t go far if you need a crown or implant.
How to Estimate Your Total Annual Cost
Your real cost in a Medicare Advantage plan is the sum of four things: your monthly Part B premium, any plan premium, your copays and coinsurance throughout the year, and your prescription drug costs. For a healthy person who rarely sees a doctor and takes no medications, a $0-premium plan could cost as little as $2,220 per year (just the Part B premium in 2025). For someone managing multiple chronic conditions, total costs could reach $5,000 to $8,000 or more, depending on the plan’s cost-sharing structure and out-of-pocket cap.
The most common mistake is choosing a plan based solely on the monthly premium. A $0-premium plan with high copays and a high out-of-pocket maximum can end up costing far more than a plan with a $50 monthly premium but lower cost-sharing. The best approach is to estimate your likely usage: how many doctor visits, which prescriptions, any planned procedures. Then compare total projected costs across a few plans rather than looking at any single number in isolation.