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«$0 premium» is the number everyone focuses on when shopping for Medicare Advantage — but it’s genuinely just one piece of what you’ll actually pay over a year. Deductibles, copays, coinsurance, and your out-of-pocket maximum all matter just as much, sometimes more. Here’s every cost component broken down with 2026 figures, so you can estimate your real annual cost, not just the headline number.
The Quick Answer
- Average Medicare Advantage premium for 2026: $14.00/month, actually down from $16.40 in 2025 — though many plans offer $0
- You still always pay Part B, regardless of your Medicare Advantage plan’s premium: $202.90/month standard for 2026
- Every plan has a maximum out-of-pocket limit, capped at $9,250 for in-network care in 2026 — your real financial safety net
- Costs beyond the premium — deductibles, copays, coinsurance — vary enormously by plan and are usually more consequential than the premium itself
The Four Cost Components of Every Plan
1. Monthly Premium
This is what you pay the insurance company itself for the plan, separate from your Part B premium. The 2026 average sits around $14/month, and it actually decreased from $16.40 in 2025 — a rare downward move. Many plans charge $0. A $0-premium plan isn’t necessarily «free» overall, though — see the trade-offs below.
2. Deductible
Some Medicare Advantage plans apply a deductible before certain coverage (often for prescriptions or specific services) kicks in; others have none. This is a real trade-off: a plan with no deductible often carries a higher monthly premium or higher copays to compensate. Never assume a plan’s deductible structure based on another plan, or based on Original Medicare — always check the specific plan’s Summary of Benefits.
If your plan includes drug coverage, note that Part D deductibles are capped separately — the maximum any plan can charge for 2026 is $615.
3. Copays and Coinsurance
These are what you pay each time you actually use a service:
- Copays are a flat fee — for example, $20 for a primary care visit
- Coinsurance is a percentage of the total cost — for example, 25% coinsurance means you pay a quarter of the bill while the plan covers the rest
Medicare Advantage plans commonly use flat copays for routine visits (rather than the 20% coinsurance structure Original Medicare uses), which is part of why many people find Medicare Advantage costs more predictable day-to-day. Out-of-network copays and coinsurance are typically higher than in-network rates — another reason network fit matters as much as the sticker price.
4. Out-of-Pocket Maximum (MOOP)
This is your annual safety net, and arguably the single most important number after you’ve confirmed your network and formulary fit. Every Medicare Advantage plan is legally required to have one. For 2026:
- The maximum allowed in-network limit is $9,250 — some plans set it lower
- Once you hit this limit, the plan covers 100% of your covered Part A and Part B costs for the rest of the calendar year
- This resets every January 1
- It does not cover prescription drug costs, which have their own separate $2,100 annual cap for 2026
What Original Medicare Alone Actually Costs You (Why the MOOP Matters So Much)
To understand why the out-of-pocket maximum is such a big deal, it helps to see what Original Medicare alone exposes you to, since it has no cap at all:
- Part A hospital deductible: $1,736 per benefit period (which can recur more than once a year if you’re readmitted)
- Part A daily coinsurance, days 61–90 of a hospital stay: $434/day
- Beyond day 90, you’re into «lifetime reserve days» at $868/day, with only 60 of these available across your entire lifetime
- Part B coinsurance: 20% of the Medicare-approved amount for most services, indefinitely, with no annual limit
Run the math on a genuinely long hospital stay: the $1,736 deductible, plus $434/day for days 61–90 (that’s another $13,020), and if you’re still hospitalized past day 90, lifetime reserve days at $868 each. A 100-day stay could exceed $23,000 in hospital costs alone under Original Medicare, before a single doctor’s bill is even counted. This is exactly the risk that Medicare Advantage’s out-of-pocket maximum — and Medigap’s more comprehensive coverage — both exist to protect you from, just through different mechanisms.
The 2026 Cost Picture, Compared
| Path | Rough monthly cost | Cost when you use care |
|---|---|---|
| Original Medicare + Medigap Plan G + Part D | ~$340–$540/month | Minimal — mostly just the $283 Part B deductible |
| Original Medicare + Medicare Advantage (with Part D bundled) | ~$202.90–$260/month | Copays and coinsurance up to your plan’s MOOP ($9,250 max) |
The honest takeaway: Medicare Advantage usually wins on predictable monthly cost; Medigap usually wins on predictable point-of-care cost. Neither is universally cheaper — it depends entirely on how much care you actually use in a given year. See our full Medicare Advantage vs Medicare Supplement guide for a deeper comparison.
Income Can Increase Your Costs: IRMAA
Regardless of which path you choose, if your income exceeds a certain threshold, you’ll pay more for Part B and Part D through the Income-Related Monthly Adjustment Amount (IRMAA). For 2026, beneficiaries earning over $109,000 individually are subject to this surcharge, based on income reported two years prior. This affects your premium costs, not your eligibility to enroll.
What to Actually Check Before Enrolling
- The specific plan’s premium — but don’t stop here
- Whether there’s a deductible, and for which services
- Copay amounts for the visits you’re likely to need — primary care, specialists, ER
- The plan’s exact out-of-pocket maximum — not just whether it exists, but the specific dollar figure
- Your prescription drug costs against the plan’s formulary, since this has a separate cap from your medical MOOP
- In-network vs. out-of-network cost differences, especially if you might need to see an out-of-network provider
Frequently Asked Questions
Is a $0 premium Medicare Advantage plan really free? No — you still pay your standard Part B premium, plus any copays, coinsurance, or deductible when you actually use care, up to your plan’s out-of-pocket maximum.
What’s the difference between a copay and coinsurance? A copay is a flat fee (like $20 for a visit); coinsurance is a percentage of the total cost (like 25% of the bill). Medicare Advantage plans commonly use flat copays for routine services, which many people find more predictable than percentage-based coinsurance.
Does the out-of-pocket maximum include my premium? No. The MOOP only covers cost-sharing (copays, coinsurance, deductibles) for Part A and Part B services. Your premium and prescription drug costs are separate.
Why did the average Medicare Advantage premium go down for 2026? The average dropped to $14.00/month from $16.40 in 2025 — a genuinely unusual downward move, reflecting broader shifts in how insurers are pricing plans this year, even as many carriers simultaneously trimmed other benefits.
Is Medicare Advantage or Medigap cheaper overall? It depends entirely on how much healthcare you use in a given year. Medicare Advantage typically has a lower predictable monthly cost; Medigap typically has more predictable costs at the point of care. Neither is cheaper for everyone.
Bottom Line
The premium is the number everyone sees first, but it’s rarely the number that determines your actual annual cost. Deductibles, copay amounts, and — above all — the plan’s specific out-of-pocket maximum tell a much fuller story. Original Medicare’s lack of any spending cap is exactly why Medicare Advantage’s MOOP (and Medigap’s alternative approach) exist in the first place, and it’s worth understanding that risk before assuming the plan with the lowest premium is automatically the best deal.
Compare the exact costs of plans available in your ZIP code using the official Medicare Plan Finder, or speak with a licensed insurance agent or your local State Health Insurance Assistance Program (SHIP) for free, unbiased guidance.
Disclaimer: Costs and figures mentioned in this article reflect 2026 CMS data and are subject to change. Always confirm current details directly with Medicare.gov, 1-800-MEDICARE, or a licensed agent before making a decision.