Medicare Advantage Costs Explained: What You'll Actually Pay
'$0 premium' is the hook, not the price. Five numbers decide what you really pay — here's how to read all of them at once.
“$0 premium” is a marketing hook, not a price tag. The true cost of a Medicare Advantage plan is the sum of five numbers. Learn to read all five together and no ad can mislead you.
The five numbers that decide your cost
| Number | What it is |
|---|---|
| Premium | The fixed monthly amount you pay for the plan (plus your Part B premium) |
| Deductible | What you pay before the plan starts sharing costs (some plans have $0) |
| Copay | A flat fee per visit or service ($20 to see a doctor, say) |
| Coinsurance | A percentage you pay for a service (20% of a procedure) |
| Out-of-pocket maximum | The yearly ceiling on what you can be charged in-network |
Why the premium is the least useful number
Counterintuitively, the premium tells you the least. A $0-premium plan can have higher copays, a drug deductible, and steep coinsurance on big-ticket care. A plan with a modest premium can have lower cost-sharing that saves you money the moment you actually use it. The premium is fixed and visible; the costs that vary are the ones that get you.
The premium is what you pay to have the plan. The other four numbers are what you pay to use it. Most people use it more than they expect.
The number that protects you: the out-of-pocket maximum
This is the most important figure in the whole plan. The out-of-pocket maximum is the most you can be charged for covered, in-network services in a year. Hit it, and the plan covers 100% of covered care for the rest of the year.
Original Medicare has no cap at all — your 20% share just keeps going. That single difference is why the out-of-pocket maximum deserves as much attention as the premium, maybe more. When you compare two plans, compare their ceilings for a bad year, not just their price in a good one.
How it adds up over a year
Picture two readers on the same $0-premium plan. One sees a doctor twice and fills one cheap prescription — their yearly cost is tiny. The other has surgery and a specialist follow-up — they may run all the way to the out-of-pocket maximum. Same plan, very different cost. That’s why you price a plan against your expected use, not a generic average.
Don’t forget the extras have their own math
Dental, vision, and hearing benefits usually come with their own annual allowances and limits. A plan might advertise rich dental coverage that’s capped at a set dollar amount per year. Treat each extra as its own line item with its own ceiling — and only count the ones you’ll really use.
The practical move
Build a simple yearly estimate for each plan you’re weighing: premium × 12, plus your expected copays and drug costs, with the out-of-pocket maximum as your worst-case backstop. Our plan-selection checklist walks through it step by step, and our scored reviews surface these cost details for the major carriers so you can compare them side by side.
This guide is educational and independent. Plan costs change every year and vary by location. Confirm the exact numbers for any plan at Medicare.gov, by calling 1-800-MEDICARE, or with your free State Health Insurance Assistance Program (SHIP).
Our picks
Top-rated Medicare Advantage plans for this
Based on our independent scoring. We may earn a commission — it never affects the ranking.
- See Humana plans in your ZIP
Humana Medicare Advantage
The best all-around pick for most people on Medicare.
- See Aetna plans in your ZIP
Aetna Medicare Advantage
A strong value play with a CVS pharmacy edge — if your local plan rates well.
- See Cigna plans in your ZIP
Cigna Healthcare Medicare Advantage
A sleeper pick in its strong markets, thin everywhere else.
Frequently asked questions
Do I still pay the Part B premium with Medicare Advantage?
Yes. You keep paying your monthly Part B premium to Medicare even when you're enrolled in a Medicare Advantage plan. Any plan premium is on top of that. Some plans even give part of the Part B premium back, which can offset the cost — but the Part B obligation itself remains.
What is the out-of-pocket maximum and why does it matter?
It's the most a Medicare Advantage plan can charge you for covered in-network care in a year. Once you hit it, the plan pays 100% of covered services for the rest of the year. Original Medicare has no such cap, which is why this single number is one of the most important in any plan.
Are dental and vision costs included in these numbers?
Usually they're tracked separately, often with their own annual allowances and limits. When you compare plans, treat the extras as a separate line — don't assume a generous dental benefit is unlimited, and read the cap.
About the author
Eleanor Hartley
Independent Medicare Analyst
Eleanor has spent over a decade analyzing Medicare Advantage and Medigap markets — comparing plan networks, drug formularies, and out-of-pocket costs across all 50 states. She sells no insurance and holds no carrier affiliation; her only loyalty is to the reader trying to pick a plan.