Medicare Part C, also called Medicare Advantage, costs most enrollees $0 in plan premiums beyond the standard Part B premium they’re already paying. About 76% of people enrolled in Medicare Advantage plans with drug coverage pay no additional monthly premium at all. For the roughly 24% who do pay a plan premium, the average is $53 per month.
But premiums are only one piece of the picture. The total cost of a Medicare Advantage plan includes copayments when you see a doctor, coinsurance for procedures, drug costs, and deductibles. Here’s how all of those costs break down.
The Part B Premium You Still Pay
Every Medicare Advantage enrollee must continue paying the standard Medicare Part B premium, which is $185 per month in 2025. This is non-negotiable. It’s the baseline cost of being in the Medicare system, and your Part C plan sits on top of it. So even when a plan advertises a “$0 premium,” that refers to the plan’s own premium, not the Part B amount.
Some plans offer what’s called a Part B giveback benefit, where the plan carrier covers part or all of your Part B premium for you. The reduction can range from as little as 10 cents per month to the full premium amount ($202.90 in 2026). The savings show up as a smaller deduction from your Social Security check or a lower amount on your Medicare invoice. It’s a credit, not cash. These giveback plans aren’t available everywhere, though. Eligibility is restricted to certain states and counties, so availability depends on where you live.
What Most People Pay in Plan Premiums
When you factor in everyone, including the majority who pay nothing, the average Medicare Advantage premium across all enrollees works out to just $13 per month in 2025. That number has actually dropped significantly over the past decade, down from $36 per month in 2015.
The wide availability of $0-premium plans is the main reason the average stays so low. These plans are funded through payments the federal government makes to insurance companies for each enrollee, which is why carriers can offer them without charging you directly. The trade-off is that $0-premium plans may have higher copayments or more limited provider networks compared to plans that charge a monthly fee.
HMO vs. PPO: How Plan Type Affects Cost
Medicare Advantage plans come in two main flavors: HMOs and PPOs. Their premiums and deductibles are broadly similar, but the real cost difference shows up in how you use them. HMO plans require you to see in-network doctors and get referrals to specialists. As long as you stay in network, costs are predictable and generally lower. PPO plans give you the flexibility to see out-of-network providers, but you’ll pay more for that freedom. In-network services through a PPO still cost less than out-of-network ones.
If you’re someone who travels frequently, splits time between two states, or wants to see specialists without a referral, a PPO may be worth the higher out-of-network costs. If you’re comfortable using a set group of local providers, an HMO will typically keep your costs lower overall.
Copayments, Deductibles, and Other Out-of-Pocket Costs
Beyond premiums, you’ll pay copayments or coinsurance each time you receive care. These amounts vary significantly from one plan to another. A primary care visit might cost you $0 to $30 depending on your plan, while a specialist visit or emergency room trip could be substantially more. The specifics are laid out in each plan’s Summary of Benefits document, which is worth reading closely before you enroll.
Many Medicare Advantage plans also charge an annual deductible for medical services, meaning you pay the full cost of care up to a certain dollar amount before your plan starts sharing costs. Some plans set this at $0, while others can be several hundred dollars. Costs for copayments, coinsurance, and deductibles all vary by plan, by state, and can change from year to year.
The Out-of-Pocket Maximum
One of the biggest financial advantages of Part C over Original Medicare is the annual out-of-pocket maximum. Original Medicare has no cap on what you might spend in a year. Medicare Advantage plans are required by law to set a ceiling on your total in-network out-of-pocket costs. Once you hit that limit, the plan covers 100% of your covered services for the rest of the year.
The exact cap varies by plan. Some set it as low as a few thousand dollars, while others go higher. Plans also set a separate, higher limit for combined in-network and out-of-network spending. When comparing plans, this number matters enormously. A plan with a low premium but a very high out-of-pocket maximum could end up costing you more in a year where you need significant medical care, like a hospitalization or surgery.
Prescription Drug Costs Within Part C
Most Medicare Advantage plans bundle prescription drug coverage (Part D) into the plan. Drug costs follow a structured system with up to three stages. First, you may need to meet a deductible before the plan helps pay for medications. No plan can set this deductible higher than $615 in 2026, and many plans have no drug deductible at all.
After the deductible, you enter an initial coverage stage where you pay 25% of the cost of your covered drugs, both generic and brand-name. This continues until your out-of-pocket drug spending reaches $2,100 in 2026. After that, you hit the catastrophic coverage stage, and you pay nothing for covered Part D drugs for the rest of the calendar year. This $2,000 cap on annual drug spending (introduced in 2025) is a significant protection that applies to all Medicare drug plans, including those built into Advantage plans.
Help Paying for Medicare Costs
If your income is limited, Medicare Savings Programs can help cover Part B premiums, deductibles, and copayments. Eligibility depends on your monthly income and available resources (savings, investments, and similar assets, but generally not your home or car).
The broadest program, the Qualified Medicare Beneficiary (QMB) program, covers Part B premiums plus deductibles and coinsurance. For 2026, you may qualify as an individual with monthly income up to $1,350 and resources under $9,950, or as a married couple with income up to $1,824 and resources under $14,910. Two other programs, SLMB and QI, help specifically with Part B premiums for people with slightly higher incomes, up to $1,816 per month for individuals and $2,455 for couples.
Many states set their eligibility thresholds above these federal minimums, and some don’t count certain types of income or assets. It’s worth applying even if you think your income is slightly too high, because state rules may work in your favor. You apply through your state Medicaid office.