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The average Medicare Advantage premium fell again for 2026. CMS projects an average of $14.00 a month across all Medicare Advantage plans, down from $16.40 in 2025, and KFF’s analysis of 2026 plans found that about three quarters of enrollees in individual plans with drug coverage pay no extra premium at all beyond Part B. Those numbers are real. They are also the smallest part of what Medicare Advantage costs in a year when you actually use medical care.
This guide adds up the full bill: the Part B premium you pay no matter what, the plan premium, the copays and coinsurance, and the annual out-of-pocket maximum that caps the damage.
The premium you cannot avoid
Every Medicare Advantage member keeps paying the Part B premium. For 2026 that is $202.90 a month at the standard rate, or $2,434.80 a year, usually deducted from your Social Security check. Higher-income members pay more under IRMAA, up to $689.90 a month. When an ad calls a plan $0 premium, it means $0 on top of that Part B amount. Our breakdown of Medicare Part B premiums in 2026 shows each income bracket.
A few plans rebate part of the Part B premium back to members, sometimes called a giveback. The rebate reduces the deduction from your Social Security check. It is a genuine saving, and it usually comes attached to plans with tighter networks or higher cost sharing elsewhere. Read the plan’s summary of benefits before treating the giveback as free money.
What care costs inside the plan
Medicare Advantage plans charge copays and coinsurance set by the plan, within federal limits. A primary care visit might carry a $0 to $25 copay. Specialists often run $30 to $50 a visit. Emergency care, imaging, outpatient surgery, and hospital stays each have their own charges, and a hospital stay is commonly billed as a daily copay for the first several days. Those daily amounts can reach several hundred dollars a day in some plans, which is how a single admission produces a bill in the thousands even though the monthly premium was $0.
Drug coverage is usually bundled in. The Part D portion of the premium inside these plans averages about $11.50 a month for 2026 according to CMS projections, folded into the plan premium rather than billed separately. Your drug costs still depend on the plan’s formulary and tiers, and the 2026 out-of-pocket cap of $2,100 on covered Part D drugs applies inside Medicare Advantage plans with drug coverage just as it does in standalone plans.
The cap that matters most
Every Medicare Advantage plan must set an annual maximum on your in-network out-of-pocket spending for Part A and Part B services. For 2026, federal rules allow that maximum to go as high as $9,250 for in-network care. Many plans set it lower, and averages sit well below the ceiling, but the number printed in your plan documents is the worst case you should budget around. Once you reach it, the plan pays 100% of covered in-network services for the rest of the year.
Original Medicare has no equivalent cap. That difference cuts both ways in the comparison. A healthy year in Medicare Advantage can cost almost nothing beyond premiums. A sick year can cost up to the plan maximum, several thousand dollars, on top of premiums. A year with Original Medicare plus a Medigap Plan G policy costs the premiums and the $283 Part B deductible, and then almost nothing, even in a sick year. Our comparison of Medicare Advantage vs Medigap works through that tradeoff in detail.
Costs that never show up in the premium
Networks shape real spending. Care outside the network costs more in a PPO and may not be covered at all in an HMO except in emergencies. Prior authorization is routine in Medicare Advantage and rare in Original Medicare, and a denied service that you choose to receive anyway becomes your bill. Plans also change every year. Copays, networks, and drug lists for 2027 arrive in the annual notice of change each fall, and the plan that cost you little in 2026 may cost more next year. Our guide to the Medicare Advantage open enrollment period lists what to compare before you switch or stay.
A realistic yearly total
Take a member in a $0 premium plan who sees a specialist monthly, has one outpatient procedure, and fills prescriptions on mid-level tiers. The premium math says $2,434.80 for the year, all of it Part B. The realistic math adds perhaps $500 to $700 in specialist copays, a few hundred for the procedure and imaging, and drug copays that could run from a few hundred dollars to the $2,100 cap. A total between $3,500 and $5,500 surprises people who anchored on the $0 in the ad, even though the coverage worked exactly as designed.
None of this makes Medicare Advantage a bad deal. For many people it is the cheapest sensible option, especially in good health. It does mean the premium is the wrong number to shop on. Shop on the out-of-pocket maximum, your doctors in the network, and your drugs on the formulary. Those three checks take twenty minutes in the Medicare Plan Finder and tell you more than any premium figure will. For the full Medicare bill across every coverage route, see how much Medicare costs in 2026.
