The premium is not what a Medicare plan costs you.
The monthly premium is the number in the advertisement. The number that decides a bad year is the out-of-pocket maximum, and it is usually printed somewhere you have to go looking for it. Here is how both work, in plain words, with no plan names and nothing to sign up for.
The out-of-pocket maximum is the number to compare. It is the most a plan can make you pay in one year for covered medical care. Medicare sets a ceiling on how high it is allowed to go, and a plan can set its own lower. A plan with no monthly premium can still carry the highest one allowed.
The number that decides your worst year
Every Medicare Advantage plan has a yearly limit on what you can be asked to pay for covered medical care. Once you reach it, the plan pays everything else that year.
| What it is | 2026 |
|---|---|
| The most any plan is allowed to charge you in a year, for care inside its network | $9,250 |
| What a typical plan actually sets its limit at | about $5,400 |
| For PPO plans, the most you can pay in a year counting care outside the network too | $13,900 |
Two things about that first row. It is a ceiling, not a price — most plans sit well under it. But about one in eleven people on a Medicare Advantage plan are in one set right at the maximum, and almost nobody picked their plan knowing that.
It resets on January 1. If you have a bad stretch in December and then surgery in the second week of January, you start again from zero. That is not a trick, it is just how a plan year works — but it is worth knowing before you schedule something.
Your premiums do not count toward it. Neither does anything the plan does not cover. The limit is about what you pay toward covered medical care — copays, the deductible, your share of a hospital stay.
A plan with no premium is not a free plan
This is the single most common misunderstanding, and it costs people real money.
You still pay Medicare
Almost everyone keeps paying the Part B premium to Medicare every month, whatever plan they join. In 2026 the standard amount is $202.90 a month, with a $283 yearly deductible. A plan advertising no premium of its own does not change that.
Zero premium, same ceiling
A plan can charge nothing monthly and still carry an out-of-pocket maximum at or near the highest allowed. You are not paying less overall — you are paying later, and only if you get sick.
The cheapest plan over a year is often not the cheapest plan today
Add twelve months of premium to what you would realistically pay in copays, and compare that against the same sum for the other plan. A plan you pay for monthly can easily come out cheaper across a year than one that looks free.
Your prescriptions move the answer more than anything else
Two plans with identical premiums can be hundreds of dollars apart over a year purely on how they cover the specific drugs you take. This is the one thing worth checking before anything else, and it is the thing people check last.
Dental, vision, hearing and the drugstore card
These are the benefits that sell plans, and “included” is not a number. The allowance is the number.
Ask what the yearly allowance is
A plan that says dental is included might give you a cleaning and not much else, or it might give you an allowance several times larger. The word is the same on both. The figure is on the plan’s benefit summary, and it is the only part worth comparing.
Most allowances do not roll over
What you do not use by December 31 is usually gone. If you are planning dental work, when you have it done matters almost as much as what the plan pays.
Ask your own dentist, not the plan
An allowance is only worth what somebody near you will accept. One phone call to the office you already go to settles it, and it is a better use of five minutes than reading the brochure again.
Hearing and the over-the-counter card
For hearing, the question is what the allowance covers once fitting and follow-up visits are counted, not the headline figure. For a drugstore card, it is what it can be spent on and in which shops — those lists are narrower than people expect.
What Medicare has not published for 2027 yet
Medicare’s own handbook for 2027 says it plainly: the 2027 premium amounts, drug costs and income limits were not available when it went to print. So the figures above are the 2026 ones, which are what you are actually paying until December 31.
The 2027 amounts normally land in November. This page gets updated when they do. If you are choosing a plan before then, the mechanics on this page are what matter anyway — the ceiling moves by a little each year, and the way it works does not move at all.
Where these come from: the out-of-pocket figures are KFF’s analysis of Medicare plan data, and the Part B amounts are from Medicare.gov. No plan or company is named anywhere on this page, and there is nothing here to enroll in.
Common questions about what Medicare Advantage costs
What is the most a Medicare Advantage plan can cost me in a year?
Every Medicare Advantage plan has a yearly out-of-pocket maximum, and Medicare sets a ceiling on how high it is allowed to go. For the 2026 plan year that ceiling is $9,250 for care inside the plan’s network, and for PPO plans $13,900 counting care outside the network as well. Most plans set theirs lower — the typical plan is around $5,400 — but roughly one in eleven people are in a plan set right at the maximum. Once you reach your plan’s limit, it pays the rest of your covered medical care for that year. Figures are for 2026 and come from KFF’s analysis of Medicare plan data; Medicare had not published the 2027 amounts as of early November 2026.
Does my monthly premium count toward the out-of-pocket maximum?
No. Premiums do not count toward it, and neither does anything your plan does not cover. The out-of-pocket maximum counts what you pay toward covered medical care — copays, the deductible and your share of a hospital stay. This is why adding twelve months of premium to what you would realistically pay in copays is the only fair way to compare two plans.
When does the Medicare Advantage out-of-pocket maximum reset?
On January 1, with the new plan year. Whatever you paid toward it the previous year goes back to zero. If you had a difficult autumn and then a procedure early in the new year, you start the count again — which is worth knowing before scheduling something that straddles the turn of the year.
Is a Medicare plan with no monthly premium actually free?
No. Almost everyone keeps paying the Part B premium to Medicare regardless of which plan they join — $202.90 a month in 2026, with a $283 yearly deductible. A plan charging no premium of its own can still carry an out-of-pocket maximum at or near the highest amount allowed, so you are not paying less overall, you are paying later and only if you get sick. Over a full year, a plan you pay for monthly is often cheaper than one that looks free.
What does dental included actually mean on a Medicare Advantage plan?
On its own it means very little, because the word is the same whether the plan gives you a cleaning or an allowance several times larger. The figure to look for is the yearly allowance on the plan’s benefit summary. Two further things decide whether it is worth anything: most allowances do not roll over, so what is unused by December 31 is usually gone, and an allowance is only worth what a dentist near you will accept — which one phone call to your own dentist settles.
Are the 2027 Medicare costs published yet?
Not as of early November 2026. Medicare’s own 2027 handbook states that the 2027 premium amounts, drug costs and income limits were not available at the time of printing. The amounts normally become available in November. Until then the 2026 figures are the ones in force, since they apply until December 31, 2026.
What will a Medicare Advantage plan cost in 2027?
Medicare had not published the 2027 amounts as of early November 2026 — its own 2027 handbook says the 2027 premium amounts, drug costs and income limits were not available at the time of printing. They normally arrive in November. Until then the 2026 figures are the ones in force, because they apply until December 31, 2026. What does not change is how the cost works: the monthly premium is not what the plan costs you, the yearly out-of-pocket maximum is the number that decides a bad year, and a plan with no premium can still carry the highest limit allowed.
Want to know what your own plan would cost?
Your doctors, your prescriptions and your ZIP code are what decide it. If the plan you already have is the right one, you will hear that too.