Most Medicare Advantage plans charge $0 in monthly plan premiums, but that’s not the full picture. You still owe the standard Part B premium of $185 per month in 2025, and you’ll face copays, deductibles, and coinsurance throughout the year that can add up to thousands of dollars depending on how much care you use.
The Monthly Premium You Always Pay
Every Medicare Advantage enrollee must continue paying the standard Medicare Part B premium, which is $185 per month in 2025. This comes directly out of your Social Security check regardless of which Advantage plan you choose. Many people overlook this cost because it’s automatically deducted, but it adds up to $2,220 per year before you use a single service.
On top of Part B, some Advantage plans charge their own monthly premium. Many popular plans set this at $0, which is one of the main reasons people choose Medicare Advantage over Original Medicare. Other plans charge anywhere from $10 to over $100 per month, typically in exchange for richer benefits, lower copays, or a broader provider network. The trade-off is real: a $0-premium plan often means higher costs when you actually need care, while a plan with a monthly premium may offer lower copays and more generous coverage.
What You Pay When You Use Services
The day-to-day costs of a Medicare Advantage plan come from copays and coinsurance each time you see a doctor, get a test, or fill a prescription. Each plan sets its own cost-sharing amounts, so there’s no single national number, but patterns are consistent. A primary care visit typically costs a flat copay in the $0 to $20 range. Specialist visits run higher, often $30 to $50 per visit.
Diagnostic imaging is where costs can climb quickly. Under Original Medicare, you pay 20% of the approved amount for an MRI or CT scan, which works out to roughly $100 to $135 depending on where the scan is performed. Medicare Advantage plans may charge a flat copay or a percentage coinsurance for these services, and the amount varies widely by plan. Some charge $50 for an outpatient MRI, others charge $250 or more. If you have a condition that requires frequent imaging, this is worth checking before you enroll.
Hospital stays are the biggest potential expense. Under Original Medicare, you pay a Part A deductible of $1,736 (2026 figure) for each benefit period, then nothing for the first 60 days. Medicare Advantage plans handle this differently. Many charge a per-day copay for inpatient stays, sometimes $200 to $400 per day for the first several days. A five-day hospitalization could cost $1,000 to $2,000 out of pocket, depending on your plan’s structure.
The Out-of-Pocket Maximum
One of the biggest financial advantages of Medicare Advantage over Original Medicare is the required annual spending cap. Original Medicare has no out-of-pocket maximum, meaning a catastrophic illness could cost you tens of thousands of dollars. Medicare Advantage plans must cap your spending.
In 2025, the maximum allowable out-of-pocket limit is $9,350 for in-network services and $14,000 for in-network and out-of-network services combined. These limits apply to Part A and Part B services only, not prescription drugs. Many plans set their actual caps well below these maximums. Once you hit your plan’s limit, the plan pays 100% of covered services for the rest of the year. If you’re comparing plans, the out-of-pocket maximum is one of the most important numbers to look at, especially if you have a chronic condition or anticipate surgery.
Prescription Drug Costs
Most Medicare Advantage plans include prescription drug coverage (Part D), and the costs follow a specific structure that changed significantly in 2025. The annual drug deductible is $590 in 2025. After meeting that deductible, you pay 25% of your drug costs during the initial coverage phase.
The major change: the old “donut hole” coverage gap no longer exists. Starting in 2025, there’s a hard $2,000 annual cap on your out-of-pocket prescription drug spending. Once you hit $2,000 in total drug costs for the year, you pay nothing more for covered medications. This is a significant reduction from previous years, where beneficiaries taking expensive medications could spend $7,000 or more annually. Plans also offer the option to spread your drug costs across monthly payments rather than paying large amounts at the pharmacy counter.
Dental, Vision, and Hearing Benefits
Medicare Advantage plans commonly include dental, vision, and hearing coverage, which Original Medicare largely does not. These benefits are funded through the plan’s rebate dollars (the savings a plan generates by operating below Medicare’s cost benchmarks) rather than through your premium. About 90% of Medicare Advantage enrollees get dental benefits included in their base plan at no extra premium. The remaining 10% pay a separate premium for dental access.
The catch is that the scope of these benefits varies enormously. Some plans cover two cleanings and an eye exam per year with modest copays but cap major dental work at $1,000 or $1,500 annually. Others offer more comprehensive dental coverage, including crowns and dentures, up to $3,000 or more. Hearing aid coverage ranges from a basic allowance of a few hundred dollars to $1,000 or more per ear. If dental or vision care matters to you, read the plan’s benefit details carefully rather than assuming “dental included” means full coverage.
HMO vs. PPO: How Plan Type Affects Cost
Medicare Advantage plans come in two main flavors, and each has a different cost profile. HMO plans generally have lower premiums and lower copays but require you to use in-network providers for all non-emergency care. If you see an out-of-network doctor, you typically pay the full cost yourself. Some HMO plans offer a “point of service” option that allows limited out-of-network care at a higher cost.
PPO plans give you the flexibility to see any provider, but you’ll pay more for going out of network. Your copays and coinsurance are higher for out-of-network care, and many PPO plans charge a monthly premium to offset the broader access. The out-of-pocket maximum for combined in-network and out-of-network spending can reach $14,000, compared to $9,350 for in-network-only caps. If your preferred doctors are all in one plan’s network, an HMO will almost always cost you less overall. If you travel frequently or see specialists outside your area, a PPO’s flexibility may justify the added expense.
Total Annual Cost Scenarios
Your real-world costs depend heavily on how much care you use. A healthy enrollee with a $0-premium plan who visits a primary care doctor three times a year and fills a couple of generic prescriptions might spend $2,500 to $3,000 total for the year, with the Part B premium making up the bulk of that. A beneficiary managing multiple chronic conditions, seeing specialists regularly, and taking several brand-name medications could spend $6,000 to $9,000 or more, depending on hospitalizations and drug costs.
The useful way to estimate your annual cost is to add four numbers together: Part B premium ($2,220 per year), any plan premium, your expected copays and coinsurance for services you regularly use, and your projected drug spending up to the $2,000 cap. Plans are required to provide a summary of benefits that lists copays for every covered service, so you can do this math with your actual usage patterns before you commit to a plan during open enrollment.