PREMIUMS, COPAYS, AND THE ANNUAL LIMIT
What Medicare Advantage Costs in 2026
A $0 plan premium can be real—but it is not the whole cost. You normally keep paying your Medicare Part B premium, and you may also have plan deductibles, copays, coinsurance, and prescription drug costs. This guide explains the 2026 figures and shows you what to compare before enrolling.
2026 Medicare costs at a glance
$202.90
Standard monthly Medicare Part B premium for 2026. Some higher-income beneficiaries pay more.
$283
Medicare Part B deductible for 2026.
$2,100
2026 annual Part D out-of-pocket threshold for covered prescription drugs.
Your plan’s limit
The medical out-of-pocket maximum is plan-specific and separate from the Part D drug limit.
Figures are national federal amounts. Plan premiums, cost sharing, drug formularies, benefits, and provider networks vary by plan and location.
How Medicare Advantage costs work
Joining a Medicare Advantage plan does not mean leaving Medicare. You remain enrolled in Medicare Part A and Part B. You generally keep paying the Part B premium, while a private insurer approved by Medicare administers your Part A and Part B benefits through the plan’s network, cost sharing, and coverage rules.
Your total cost can therefore have two layers:
- Medicare costs, such as the Part B premium and, for some people, a Part A premium or an income-related surcharge.
- Plan costs, such as a plan premium, medical deductible, copays, coinsurance, and covered prescription drug costs.
The plan premium is only one part of the decision. Hospital copays, specialist costs, drug coverage, provider networks, prior-authorization rules, and the annual out-of-pocket limit can matter much more in a year when you need significant care.
Every cost that can appear on a Medicare Advantage plan
The federal government sets some costs. The insurance company sets others within Medicare’s rules. Anything set by the plan can vary by plan and county.
On a small screen, swipe the table sideways to see every column.
| Cost | Who sets it | 2026 amount | What to review |
|---|---|---|---|
| Part B premium | Federal government | $202.90 per month for most beneficiaries; more for some higher-income beneficiaries | You normally continue paying this premium. A plan offering a Part B giveback may reduce the amount withheld, subject to the plan’s terms. |
| Part A premium | Federal government | $0 for most people; $565 per month for people with fewer than 30 quarters of qualifying work | If you owe a Part A premium, enrolling in Medicare Advantage does not eliminate it. |
| Plan premium | Insurance company | $0 for many plans; CMS estimated a $14 average monthly premium across all Medicare Advantage plans in 2026 | A $0 premium does not describe the plan’s copays, network, drug coverage, or maximum financial exposure. |
| Medical deductible | Insurance company | Varies by plan | Check whether a deductible applies to all medical services or only to certain types of care. |
| Copays and coinsurance | Insurance company | Varies by service and plan | Compare specialist visits, hospital stays, imaging, outpatient surgery, ambulance services, and other care you are likely to use. |
| Part D prescription drug costs | Insurance company within federal rules | Deductible, tiers, and cost sharing vary; the 2026 annual out-of-pocket threshold is $2,100 | Drug spending is separate from the plan’s medical out-of-pocket limit. Check every medication by exact name, dose, and quantity. |
Plan-set amounts vary by county and may change each plan year. Always verify the current Evidence of Coverage, Summary of Benefits, formulary, and provider directory before enrolling.
THE NUMBER THAT CAPS YOUR MEDICAL RISK
The medical out-of-pocket maximum
Every Medicare Advantage plan must place an annual limit on what you pay for covered Part A and Part B services. Original Medicare by itself does not have an annual out-of-pocket limit.
Once you reach your plan’s applicable in-network medical limit, the plan generally pays the covered in-network Part A and Part B costs for the rest of that calendar year. The limit resets each January 1.
Costs that generally count
- Medical deductibles
- Copays for covered medical services
- Coinsurance for covered medical services
- Applicable in-network Part A and Part B cost sharing
- On certain PPO plans, out-of-network cost sharing toward a separate combined limit
Costs that generally do not count
- Your monthly Part B premium
- Your Medicare Advantage plan premium, if any
- Part D prescription drug costs
- Services the plan does not cover
- Non-emergency out-of-network care an HMO does not cover
Your plan’s Evidence of Coverage controls what counts. Compare the actual limit for every plan you are considering rather than relying only on a national ceiling or average.
A healthy year and a high-use year
The following example shows how the cost structure works. It is not a quote or a description of a particular plan.
Illustrative plan: $0 monthly plan premium, no general medical deductible, and a $4,500 in-network medical out-of-pocket maximum.
On a small screen, swipe the table sideways to see both examples.
| Line item | Healthy year | Year with hospital care and surgery |
|---|---|---|
| Part B premium for 12 months | $2,434.80 | $2,434.80 |
| Plan premium | $0 | $0 |
| Specialist visits | $90 | $360 |
| Imaging and laboratory services | $0 | $525 |
| Five-day inpatient stay | $0 | $1,750 |
| Outpatient surgery | $0 | $395 |
| Physical therapy | $0 | $720 |
| Medical cost-sharing subtotal | $90 | $3,750 |
| Part D drug costs | $180 | $2,100 |
| Illustrative annual total | $2,704.80 | $8,284.80 |
This example demonstrates two points: the Part B premium continues in both years, and Part D drug spending is separate from the medical out-of-pocket calculation. Actual costs depend on the plan, services received, provider network, drug formulary, pharmacy, eligibility for assistance, and other circumstances.
Medicare Advantage, Original Medicare, and Medigap costs
These approaches distribute financial risk differently. None is automatically cheapest for every person in every year.
On a small screen, swipe the table sideways to compare all three options.
| Feature | Medicare Advantage | Original Medicare alone | Original Medicare with Medigap |
|---|---|---|---|
| Monthly cost | Part B premium plus any plan premium | Part B premium | Part B premium, Medigap premium, and usually a separate Part D premium |
| Annual medical limit | Required under the plan | No annual limit | Cost sharing may be substantially reduced, depending on the Medigap plan |
| Provider access | Plan network and rules apply | Any provider that accepts Medicare | Any provider that accepts Medicare |
| Prescription coverage | Often included | Separate Part D plan needed | Separate Part D plan needed |
| Additional dental, vision, or hearing benefits | May be included; varies by plan | Not generally included | Not generally included by Medigap |
| Cost pattern | Often lower monthly cost with more pay-as-you-use cost sharing | Lower monthly cost but no annual medical cap | Higher, more predictable monthly cost with lower medical cost sharing on many plans |
| Changing coverage later | Changes allowed during applicable enrollment periods | Changes allowed during applicable enrollment periods | Medigap availability, pricing, guaranteed-issue rights, and underwriting rules vary by timing and state |
Someone considering a move from Medigap to Medicare Advantage should understand that returning to Medigap later may not be guaranteed outside applicable rights or enrollment protections. Review the timing and state-specific rules before making a change. Read more about Medicare enrollment periods and Medicare Supplement insurance.
How to estimate your own Medicare Advantage costs
1
Review the care you actually used
List last year’s specialist appointments, imaging, therapy, hospital stays, outpatient procedures, and other recurring services. Your own history is more useful than a generic average.
2
List every prescription exactly
Record the name, dose, quantity, and preferred pharmacy. The same medication can fall on different tiers from one plan to another, and formularies can change.
3
Confirm your doctors and hospitals
Check the plan’s current provider directory and confirm participation with the provider’s office. Networks can change, and the provider—not just the medical group—must be checked.
4
Calculate a typical year and a high-use year
Add the cost sharing you would expect in an ordinary year. Then compare the plan’s medical out-of-pocket maximum, hospital costs, drug exposure, and out-of-network rules for a high-use year.
This is the comparison James can walk through with you using your doctors, prescriptions, and priorities.
Frequently asked questions about Medicare Advantage costs
Do I still pay the Part B premium with Medicare Advantage?
Usually, yes. You remain enrolled in Medicare Part B and generally continue paying the Part B premium. Some plans may offer a Part B premium reduction or “giveback,” but availability and amounts vary by plan and location.
What is the most I can pay in a year?
Your Medicare Advantage plan sets an annual limit for covered Part A and Part B cost sharing within federal requirements. Look for the plan’s specific in-network maximum and, for a PPO, any combined in- and out-of-network maximum. Premiums, Part D drug costs, and noncovered services generally do not count toward that medical limit.
Is a $0-premium plan lower quality?
Not necessarily. Premium alone does not measure quality or fit. Compare the plan’s provider network, drug formulary, Star Rating when applicable, prior-authorization rules, cost sharing, benefits, and annual out-of-pocket maximum.
Can Medigap pay my Medicare Advantage copays?
No. Medigap policies are designed to work with Original Medicare, not Medicare Advantage. A person cannot use a Medigap policy to cover Medicare Advantage deductibles, copays, or coinsurance.
Are dental, vision, hearing, or over-the-counter benefits free?
Some Medicare Advantage plans include additional benefits, but the amounts, networks, covered services, frequency limits, and other rules vary. Review the plan documents rather than choosing a plan based only on an advertised allowance.
What happens if I move?
Medicare Advantage plans have service areas. Moving outside a plan’s service area can trigger a Special Enrollment Period, while a move within the service area may change the options available. Report the move and compare the plans available at the new address.
Do people with Medicare and Medicaid pay the same costs?
Not always. Medicaid and programs such as Medicare Savings Programs or Extra Help may reduce eligible beneficiaries’ premiums and cost sharing. Eligibility and assistance depend on the person’s circumstances and state rules. Learn more about Medicare and Medicaid eligibility.
Does it cost extra to work with O’Neal Insurance Group?
O’Neal Insurance Group does not charge an additional fee for its Medicare plan guidance. Confirm this statement internally and retain any required compensation or carrier disclosures before publication.
OFFICIAL RESOURCES
Verify the figures and get personal help
Medicare.gov and CMS publish official Medicare cost information. The Medicare Plan Finder shows plans available for a particular ZIP code. A licensed insurance agent can help compare those options against your prescriptions, providers, preferred pharmacies, and budget.
- CMS: 2026 Medicare Parts A & B premiums and deductibles
- CMS: Final CY 2026 Part D Redesign Program Instructions
- CMS: Medicare Advantage rates and out-of-pocket calculations
- Medicare.gov: How Medicare Advantage works
Written and reviewed by James O’Neal
Licensed insurance agent and broker
NPN 770576 · California producer number 4161407
Reviewed August 2026 against published 2026 CMS figures. About James O’Neal
O’Neal Insurance Group and James O’Neal are not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability and benefits vary by service area. This page is educational and is not a complete description of any plan’s benefits. Review all required Medicare marketing, carrier, compensation, and TPMO disclosures with the agency’s compliance contact before publication.
PERSONAL GUIDANCE