Medicare Part C, commonly called Medicare Advantage, costs most enrollees nothing beyond the standard Part B premium they already pay. About 76% of people enrolled in individual Medicare Advantage plans with drug coverage pay $0 in additional monthly premiums. For those who do pay, the national average premium is just $13 per month, though the total cost of a plan depends on deductibles, copays, and how much care you actually use throughout the year.
Monthly Premiums
Every Medicare Advantage enrollee must continue paying the standard Part B premium, which is set by the federal government each year. The Part C plan premium sits on top of that. Because Medicare Advantage plans receive a per-person payment from the federal government, many insurers can offer $0-premium plans, especially in competitive metro areas where multiple insurers are vying for enrollees.
Plans that charge a premium typically offer richer benefits, wider provider networks, or lower cost-sharing at the point of care. A $0-premium plan is not automatically the cheapest option over a full year. If it comes with higher copays for specialist visits or a larger deductible, you could end up spending more than someone paying $40 or $50 a month for a plan with lower out-of-pocket costs. Comparing the total estimated annual cost, not just the premium, is the most reliable way to choose.
Out-of-Pocket Maximums
One of the biggest financial protections in Medicare Advantage is the annual out-of-pocket maximum, something Original Medicare does not offer. Once you hit this cap, your plan covers 100% of covered services for the rest of the year. CMS sets a ceiling that no plan can exceed. For in-network services, the mandatory cap has been set at $8,300 (based on the 2023 contract year figure, which CMS adjusts periodically). For combined in-network and out-of-network services, the mandatory limit was $12,450.
Many plans set their caps well below these maximums to attract enrollees. When comparing plans, check whether the listed cap applies only to in-network care or includes out-of-network spending, because the difference can be thousands of dollars if you need to see providers outside the network.
Deductibles and Copays
Medical deductibles in Medicare Advantage plans vary widely. Some plans have no medical deductible at all, while others require you to pay a few hundred dollars before coverage kicks in. For prescription drug coverage built into the plan, no Medicare drug plan can charge a deductible higher than $615 (2026 figure), and many set it lower or waive it entirely.
After you meet any deductible, you’ll pay copays or coinsurance each time you receive care. Each plan sets its own amounts. A primary care visit might carry a $0 to $30 copay, while specialist visits, imaging, and hospital stays typically cost more. These amounts are locked in for the calendar year and listed in the plan’s Evidence of Coverage document, so you can compare them side by side before enrolling.
HMO vs. PPO Plan Costs
Most Medicare Advantage plans are structured as either an HMO or a PPO. The baseline cost categories are the same for both: monthly premiums, deductibles, copays, and coinsurance. The key cost difference comes down to what happens when you go outside the plan’s network.
With an HMO, you generally must use in-network providers. If you see someone outside the network for non-emergency care, you typically pay 100% of the bill yourself. PPO plans give you the flexibility to see out-of-network providers, but you’ll owe higher copays or coinsurance for doing so, and those costs count toward a higher combined out-of-pocket maximum. If you rarely travel and are comfortable with a defined network, an HMO plan often costs less over the course of a year. If you want more flexibility or see specialists in different regions, a PPO may be worth the added cost.
Dental, Vision, and Hearing Benefits
One reason Medicare Advantage has grown so popular is that most plans bundle dental, vision, and hearing coverage that Original Medicare doesn’t provide. These extras are usually included in the plan premium at no additional charge, though the depth of coverage varies significantly.
About 10% of Medicare Advantage enrollees are in plans that require a separate premium to access dental benefits. For hearing exams, the majority of plans that charge cost-sharing set copays between $15 and $50. Hearing aid fittings and evaluations follow a similar pattern, with roughly 5% of enrollees in plans that charge copays in that same $15 to $50 range. Vision benefits commonly cover routine eye exams and a basic eyewear allowance. Before enrolling, check whether the plan covers only preventive services (like cleanings and exams) or also covers more extensive procedures like crowns, dentures, or cataract surgery.
Income-Related Surcharges
If your income exceeds certain thresholds, you’ll pay a surcharge on the prescription drug portion of your Medicare Advantage plan. This is called the income-related monthly adjustment amount, or IRMAA. It’s based on your tax return from two years prior.
For 2026, single filers with modified adjusted gross income above $109,000 pay an extra $14.50 per month on top of their plan premium. The surcharge increases in steps: $37.50 for income above $137,000, $60.40 above $171,000, $83.30 above $205,000, and $91.00 at $500,000 or more. For married couples filing jointly, the thresholds are roughly doubled: the first surcharge kicks in above $218,000, with the highest tier starting at $750,000.
If you’ve had a life-changing event like retirement, divorce, or the death of a spouse that significantly reduced your income, you can request that Social Security use a more recent tax year instead.
Late Enrollment Penalties
If you go 63 or more continuous days without Medicare drug coverage or equivalent coverage from another source, you may face a permanent late enrollment penalty when you eventually sign up for a plan that includes drug coverage. Medicare calculates the penalty by multiplying 1% of the national base beneficiary premium (which was $34.70 in 2024) by the number of full months you went without coverage. That amount gets added to your monthly premium for as long as you have Medicare drug coverage.
For example, if you went without coverage for 10 months, the penalty would be roughly $3.50 per month, adjusted each year as the base premium changes. Over a decade or more of Medicare enrollment, even a small monthly penalty adds up considerably. This is one reason many people choose a Medicare Advantage plan with built-in drug coverage right when they first become eligible.
How to Estimate Your Total Annual Cost
The true cost of a Medicare Advantage plan is not the premium alone. To get a realistic picture, add up four components: your monthly premium (times 12), the plan’s deductible, the copays you’d expect based on how often you see doctors and fill prescriptions, and any IRMAA surcharge if it applies to you. Medicare’s online Plan Finder tool lets you enter your specific medications and preferred providers to generate a personalized cost estimate for every plan available in your zip code.
Plans change their cost-sharing and benefits every year, so what worked well this year may not be the best value next year. Reviewing your options during the annual enrollment period each fall, which runs from October 15 through December 7, is the most effective way to keep costs in check.