Medicare Advantage, also called Medicare Part C, provides Medicare Part A and Part B benefits through Medicare-approved private plans. Unlike Original Medicare, where many costs follow federal cost-sharing rules, Medicare Advantage plans establish their own premiums, deductibles, copayments, and coinsurance within Medicare requirements. These costs can differ considerably between plans, so understanding each component is important when reviewing coverage.
A premium is an amount paid for health coverage. Some Medicare Advantage plans have a $0 monthly plan premium, while others charge an additional monthly amount. Even when a Medicare Advantage plan has no additional premium, beneficiaries generally continue paying their Medicare Part B premium. In 2026, the standard Part B premium is $202.90 per month, although some people pay more based on income.
A deductible is the amount a person may need to pay for covered services before the plan begins paying according to its cost-sharing structure. Medicare Advantage plans can have an overall yearly deductible or separate deductibles for particular services. The specific amount depends on the plan.
When comparing Medicare Advantage costs, consider:
Monthly Medicare Advantage plan premium
Medicare Part B premium
Annual medical deductible
Separate deductibles for certain services
Whether the plan provides any Part B premium reduction
Provider network requirements
Prescription drug coverage and related costs
Because Medicare Advantage plans differ, the premium alone does not show the full potential cost of coverage. A plan with a lower monthly premium may have different deductibles or cost-sharing requirements than another plan.
A copayment, or copay, is a set amount paid for a covered healthcare service, such as a doctor visit. Coinsurance is generally a percentage of the cost that a beneficiary pays after meeting applicable requirements. Medicare Advantage plans determine these amounts according to their benefit structures.
For example, one plan might charge a fixed copayment for a primary care visit, while another may use different cost-sharing amounts for specialists, hospital services, diagnostic procedures, or other covered care. The amount can also depend on whether a provider is inside or outside the plan’s network, when the plan permits out-of-network care.
Important cost considerations include:
Copayments for primary and specialist visits
Hospital and outpatient service costs
Coinsurance for certain covered services
Prescription drug costs when drug coverage is included
In-network and out-of-network cost differences
The plan’s annual out-of-pocket maximum
One important feature of Medicare Advantage is its yearly limit on out-of-pocket spending for covered services. Once a beneficiary reaches the plan’s applicable limit, the plan pays 100% of covered health services for the remainder of the year. The specific limit and the services that count toward it are determined by the plan.
Prescription drug expenses have separate rules. For 2026, Medicare prescription drug coverage has a $2,100 annual out-of-pocket limit for covered Part D drugs. This limit applies to covered prescription drugs and is distinct from the medical out-of-pocket structure of a Medicare Advantage plan.
Understanding Medicare Advantage premiums, deductibles, copayments, coinsurance, and out-of-pocket limits can make healthcare cost information easier to evaluate. Because costs and benefits vary by plan, reviewing the specific plan documents is important before making coverage decisions. Beneficiaries can consider both predictable monthly expenses and potential healthcare costs when examining Medicare Advantage coverage.