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75% Pay $0: Medicare Advantage Premiums in 2026 for U.S. Enrollees

Hands comparing Medicare costs with calculator

Most Medicare Advantage enrollees will pay no supplemental premium at all in 2026, but that doesn’t mean the plan is free. You still owe the standard $202.90 Part B premium, and the average supplemental MA premium sits near $14 for those who do pay one. The number that actually determines whether a plan is a good deal is the out-of-pocket maximum, which is typically several thousand dollars in-network, well below the federal cap of $9,250. Compare total annual cost, not the sticker price, before you enroll.

TL;DR:

  • The federal MOOP cap is $9,250 for in-network services, but the average in-network MOOP across plans is around $5,421, often well below the cap.
  • About 75% of MA-PD enrollees pay only the Part B premium of $202.90 monthly, with an average supplemental premium near $14 for those who pay more.
  • Rebate funds from CMS are used by insurers mainly to lower premiums, reduce cost-sharing, or add benefits; plan differences depend on how rebates are allocated.
  • Comparing plans requires evaluating providers, medications, out-of-pocket limits, and network details, not just premiums, especially for complex health needs.
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Medicare Advantage Premiums 2026: The Numbers That Matter

The 2026 numbers break into three separate buckets, and conflating them is the most common mistake beneficiaries make when comparing plans. There’s Part B, which everyone pays regardless of whether they choose Medicare Advantage. There’s the MA plan’s own supplemental premium, which many people don’t pay at all. And there’s Part D drug coverage, which runs on its own separate cost track entirely.

Start with Part B. The standard monthly premium for 2026 is $202.90, and the annual deductible is $283. This is non-negotiable. Whether you stay on Original Medicare or enroll in a Medicare Advantage plan, this premium comes out of your Social Security check or gets billed to you directly. Higher earners pay more through IRMAA, the income-related monthly adjustment amount, which can push the total Part B premium as high as $689.90 for the top income bracket.

Here’s the part that surprises people shopping for a Medicare Advantage plan: CMS estimates that roughly 75% of individual MA-PD enrollees pay no premium beyond that Part B amount. For the remaining quarter who do pay a supplemental premium, the average is projected at about $14 a month. That’s a genuinely low number, and it explains why “$0 premium” plans dominate Medicare Advantage marketing in Central Oregon and everywhere else.

2026 Medicare cost snapshot:

  • Standard Part B premium: $202.90/month
  • Part B annual deductible: $283
  • Average MA supplemental premium: low for most enrollees
  • Average in-network out-of-pocket maximum: typically several thousand dollars
  • Federal in-network MOOP cap: $9,250
  • Average combined (in and out-of-network) MOOP: generally under the federal cap
  • Federal combined MOOP cap: $13,900

The number that matters most isn’t the premium. It’s the out-of-pocket maximum. KFF’s analysis puts the enrollment-weighted average in-network MOOP at $5,421 for 2026, well under the $9,250 ceiling CMS allows. That gap between average and maximum is where plan quality actually lives.

One more thing to keep separate in your head: Part D. Prescription drug spending under Medicare Advantage plans that include drug coverage (MA-PD plans) doesn’t count toward your medical MOOP. Drug costs run on their own track, with their own deductible and cost-sharing structure, so a plan that looks cheap on medical out-of-pocket exposure can still hit you hard on prescriptions if you take expensive medications.

Why Do Some Medicare Advantage Plans Charge $0 Premiums?

The mechanics behind a $0 premium Medicare Advantage plan come down to a federal payment formula, not generosity. Every county has a CMS-set benchmark, essentially a ceiling for how much the government will pay a private plan to cover a Medicare beneficiary there. Insurers submit bids for how much they think it will cost to provide Medicare-covered benefits. When a plan’s bid comes in below the benchmark, CMS pays the plan part of the difference back as a rebate.

Those rebates aren’t small. MedPAC estimates rebates will average nearly $2,400 per enrollee in 2026 for individual plans. Insurers are required to spend that rebate money on the enrollee in one of a few specific ways:

  • Lowering or eliminating the plan’s Part B or supplemental premium
  • Reducing cost-sharing (copays, coinsurance, deductibles)
  • Adding supplemental benefits like dental, vision, hearing aids, or fitness programs
  • Reducing Part D drug costs

This is why you’ll see wildly different plan designs in the same county. One insurer might use its rebate to zero out the supplemental premium and offer a $3,000 dental allowance. Another might keep a small premium but push the savings into a lower MOOP and richer specialist coverage. Neither approach is objectively better. It depends entirely on how much health care and how many prescriptions you actually use.

About one-third of MA plans go a step further and use part of their rebate to directly reduce your Part B premium, not just the plan’s own premium. A $50 monthly Part B rebate adds up to $600 a year, and it rarely shows up prominently in plan marketing, so ask about it directly.

Plan type and local market competition also shape whether a supplemental premium appears at all. HMOs, which restrict you to a narrower network, generally have more room to negotiate lower provider rates and often carry lower premiums and MOOPs than PPOs, which give you more flexibility to see out-of-network providers at a cost.

Pro Tip: Don’t judge a plan by its premium alone. Two plans in the same Deschutes County zip code can both advertise $0 premiums and still differ by thousands of dollars in what you’d pay in a bad health year, depending on how each one structured its rebate.

The takeaway that matters for your decision: a rock-bottom monthly premium tells you almost nothing about what you’ll spend if you get sick, need a specialist, or fill an expensive prescription. It tells you what the plan chose to advertise.

What Do Out-of-Pocket Limits Actually Cover in 2026?

Two figures matter here, and plans are required to report both.

The federal maximum for in-network services in 2026 is $9,250. For combined in-network and out-of-network spending (relevant mainly for PPOs), the cap rises to $13,900. Those are legal ceilings, not typical experiences. The enrollment-weighted average in-network MOOP across all plans is $5,421, and the average combined limit runs $9,825. Most plans set their actual limit well below the federal cap because a lower MOOP is a competitive selling point.

Here’s where plan type creates a real divide:

  • HMOs tend to post lower MOOPs and lower premiums, but you’re generally locked into an in-network provider list and need referrals for specialists.
  • PPOs allow out-of-network care, which is valuable if you split time between states or want flexibility, but that flexibility usually comes with a higher MOOP and sometimes a higher premium.
  • Combined caps only apply if you use out-of-network care. If you stay in-network the whole year on a PPO, the lower in-network figure is what governs your spending.

Remember that Part D isn’t included in any of these MOOP figures. Prescription drug costs run through their own separate structure with their own deductible, and the out-of-pocket accounting is entirely distinct from your medical MOOP. If you take several brand-name medications, your realistic annual cost ceiling is your plan’s MOOP plus whatever you’ll spend on Part D, not the MOOP alone.

For a mental model, think in two scenarios rather than one number. In a light year, healthy, routine checkups, maybe a generic prescription, you’ll likely pay far less than the average MOOP. In a heavy year, a hospitalization, a new specialist, a costly biologic drug, you could realistically hit the plan’s full out-of-pocket limit. A resilient plan choice is one where even the heavy-year number doesn’t wreck your budget.

What Do Out-of-Pocket Limits Actually Cover in 2026? — overview diagram

What Else Changes What You’ll Actually Pay?

Premium and MOOP are the headline figures, but five other variables usually decide your real annual cost, and they’re easy to overlook when you’re comparing plan brochures side by side.

  1. Income and IRMAA. If your modified adjusted gross income from two years prior exceeds $109,000 (individual) or $218,000 (joint), the Social Security Administration adds a surcharge to your Part B premium, on top of any Medicare Advantage costs. If your income dropped since that tax year, due to retirement, a life event, or a one-time capital gain, you can file for a reconsideration with SSA rather than accepting the higher bracket by default.
  2. Network access. A plan’s directory listing your cardiologist doesn’t guarantee smooth access. Provider networks change mid-year, and some listed providers have limited appointment slots for new Medicare Advantage patients. Call the provider’s office directly to confirm current participation.
  3. Cost-sharing structure. Two plans with identical MOOPs can front-load costs differently, one might charge $0 for primary care visits but $350 per hospital admission, another the reverse. Match the structure to how you actually use care.
  4. Prior authorization and formulary tiers. Many MA plans require prior authorization for imaging, certain procedures, or specialty drugs. Check your specific medications against the plan’s drug formulary tiers before assuming a low premium covers everything.
  5. County-level variation. Because CMS benchmarks are set at the county level, a plan can look completely different one county over. Central Oregon residents should pull the CMS landscape file for their specific county rather than assuming statewide averages apply.

How Do You Actually Compare 2026 Medicare Advantage Plans?

Comparing plans by premium alone is how people end up with unpleasant surprises in March when a hospital bill arrives. A more reliable process takes maybe 30 minutes and gives you an actual number to compare, not just a feeling.

  1. List your providers and medications first. Write down every doctor you see regularly and every prescription drug, including dosage, before you look at a single plan. This list is what you’ll test each plan against, not the other way around.
  2. Pull the total monthly cost for each plan you’re considering. Add Part B ($202.90, or your IRMAA-adjusted amount) plus the plan’s supplemental premium plus its Part D premium if separate. This is your guaranteed monthly floor regardless of how much care you use.
  3. Check the MOOP and whether it’s in-network only or combined. Note the actual dollar figure, not just whether it’s “low” relative to competitors.
  4. Confirm your providers are in-network by calling, not just checking the directory. Directories lag behind real network changes; a local review of provider participation often catches gaps online tools miss.
  5. Ask about prior authorization rules for anything you use regularly, imaging, physical therapy, specialty drugs. A plan that requires prior authorization for a treatment you need every few months adds friction and delay, even if it doesn’t add direct cost.
  6. Ask specifically how the plan uses its rebate. Does it reduce your Part B premium? Lower cost-sharing? Fund supplemental benefits? The answer changes what you’re actually getting for the price.

When you’re on the phone with a plan representative or an agent, four questions cut through the marketing quickly: What happens if I need to see a specialist outside this network temporarily? What would my estimated annual drug cost be under this plan’s formulary for my specific medications? What’s my realistic worst-case out-of-pocket total if I’m hospitalized this year? And does any part of this plan’s rebate reduce my Part B premium directly?

Medicare lets you run these numbers yourself using your zip code, and the CMS landscape files give you the underlying county-level data behind what the tool displays, useful if you want to double-check a plan’s self-reported figures against the federal source.

Pro Tip: If your situation involves multiple specialists, a complex drug regimen, or you’re weighing Medicare Advantage against a Medigap policy for the first time, this is exactly the kind of comparison where an extra set of eyes catches things a plan-finder tool won’t, like whether your specific specialist is actually accepting new Medicare Advantage patients this year.

If your health picture is simple, one or two medications, an annual physical, running these numbers yourself is entirely doable in an afternoon. If it’s more complicated, get a second opinion before you sign anything during the Annual Enrollment Period.

Are $0 Premium Medicare Advantage Plans Actually a Good Deal?

A $0 premium plan isn’t a red flag, and it isn’t a giveaway either. It simply means the insurer chose to put its rebate dollars toward eliminating the supplemental premium instead of, say, lowering your MOOP or adding a generous dental benefit. The trade-off usually shows up somewhere else in the plan design.

Common patterns worth watching for: $0 premium plans sometimes carry higher copays for specialist visits or hospital stays, narrower provider networks, or thinner supplemental benefit allowances than plans charging a small monthly premium. None of this makes them worse. For a healthy retiree who rarely sees a specialist and takes no regular medications, a $0 premium HMO with a modest MOOP can be close to ideal.

The risk shows up for people who underestimate their own utilization. If you assume you’re healthy and pick the cheapest-looking plan, then get diagnosed with something requiring ongoing specialist care mid-year, you’re locked into that plan’s cost-sharing structure until the next enrollment period. The premium never told you that was coming.

The honest way to evaluate a $0 premium plan is to run it through the same two-scenario test as any other plan: a light-utilization year and a heavy one. If the heavy-year number under a $0 premium plan is close to what you’d pay under a plan charging $25 a month with a lower MOOP, the free premium probably isn’t the better deal. If both scenarios come out favorably, the $0 premium plan earns its reputation honestly.

Have Medicare Advantage Premiums Been Rising or Falling?

The 2026 trend continues a pattern that’s held for several years: average supplemental premiums for Medicare Advantage plans have generally trended downward or stayed flat, even as overall MA enrollment has grown substantially. CMS has repeatedly projected stability in average premiums heading into 2026, continuing a run of years where the advertised average premium has stayed in the same narrow band.

This might seem counterintuitive. Health care costs generally rise every year, so why hasn’t the average MA premium followed? Part of the answer is competitive pressure, insurers use rebates to keep supplemental premiums low because it’s the number consumers see first in plan marketing, even when they shift costs elsewhere through cost-sharing or narrower networks. Part of the answer is that CMS benchmark payments to plans have kept pace with, or in some counties exceeded, actual cost growth, giving insurers room to bid competitively.

What has changed more noticeably over the same stretch is out-of-pocket structure. MOOPs, formulary tiers, and prior authorization requirements have gotten more complex even as headline premiums held steady. That’s the shift worth paying attention to. If you enrolled in a Medicare Advantage plan five years ago and haven’t checked your plan’s current MOOP or drug formulary, the premium probably looks familiar, but the cost-sharing details underneath it may have moved more than you’d expect. Reviewing your plan every Annual Enrollment Period, even if you’re happy with it, catches this kind of quiet drift.

What Coverage Do You Actually Get at Different Premium Levels?

Premium level and covered services don’t correlate as cleanly as most people assume. Every Medicare Advantage plan, whether it charges $0 or $80 a month, must cover everything Original Medicare covers: hospital stays, doctor visits, lab work, and preventive care. That baseline is federally required and doesn’t change with price.

What actually varies by premium tier is supplemental benefits and network breadth. Higher-premium plans more often bundle in comprehensive dental (crowns and root canals, not just cleanings), broader vision allowances, hearing aid coverage, and sometimes extras like meal delivery after a hospital stay or a fitness membership. Lower or $0 premium plans may offer thinner versions of these same benefits, a basic dental cleaning allowance instead of a full dental plan, for instance, or no hearing aid benefit at all.

Network breadth often tracks with plan type more than premium. A higher-premium PPO buys you flexibility to see out-of-network specialists at a cost; a $0 premium HMO in the same county might restrict you to a tighter provider list but deliver essentially the same core medical coverage.

Before assuming a higher premium buys better care, check the plan’s Evidence of Coverage document for the specific benefit you care about, dental limits, hearing aid allowances, over-the-counter benefit cards. The premium is a poor proxy for benefit richness; the benefit summary is the only reliable source.

How Do Premiums, Deductibles, and Copays Work Together?

Your premium is the toll you pay just to hold the plan; deductibles and copays are what you pay when you actually use it. Treating these as one combined number is where most people miscalculate their real annual Medicare cost.

Here’s how the pieces stack for a hypothetical MA-PD plan with a $10 monthly supplemental premium: you’re locked into $202.90 (Part B) plus $10, or $212.90 a month, or $2,554.80 a year, before you see a single doctor. Then, if you need care, you owe whatever the plan’s deductible and copay structure specifies for each service, up to the annual MOOP.

Medicare premium and out-of-pocket cost breakdown

This is why a plan with a slightly higher premium but lower copays can beat a $0 premium plan for someone who visits doctors frequently. Run the math: if Plan A charges $0 premium but $50 per specialist visit, and Plan B charges $15 a month but only $25 per specialist visit, four specialist visits a year makes Plan B cheaper overall, at $280 total against Plan A’s $200, but the gap narrows or reverses depending on how many visits you actually expect.

Prescription drugs add another layer. Under Part D, you pay a separate deductible (which varies by plan) before copays or coinsurance kick in for medications, and that spending doesn’t touch your medical MOOP at all. Someone on three maintenance medications should estimate their Part D year separately from their medical MOOP year, then add both together for a true annual total.

The Real Lesson Buried in the 2026 Numbers

The conventional advice, “shop by premium,” is backwards for most Medicare Advantage enrollees, and the 2026 numbers make that obvious once you line them up. A $14 average difference in supplemental premium is trivial next to a MOOP gap that can run into the thousands. Yet premium is still the number plan finder tools sort by first, and it’s the number most marketing leads with.

What the data actually supports is prioritizing MOOP and formulary fit over premium, in that order. The federal government set a $9,250 in-network ceiling for a reason: even a “good” plan can expose you to that much risk in a bad year. Most enrollees will never hit it, but you’re not most enrollees when you’re the one in a hospital bed.

Where I think the guidance genuinely falls short is in treating rebates as a footnote. A rebate quietly funding your Part B reduction or your dental allowance is real money, and most beneficiaries never ask how a plan is spending it. Ask. It’s a fair question, and a good agent or plan representative should answer it without hesitation.

— Jesse Zimmerman

Get Help Comparing Plans Before You Enroll

Running the premium, MOOP, and drug cost numbers yourself gets you most of the way there, but confirming that your specific providers and prescriptions actually work with a specific plan takes a local check most online tools can’t do. Free, no-pressure Medicare consultations are available for Central Oregon residents, offered both in person and remotely, and built around education rather than a sales quota.

A consultation typically covers your Part B and IRMAA situation, a side-by-side look at Medicare Advantage plan premiums available in your county, your realistic MOOP exposure based on how you use care, network verification for your actual doctors, and a Part D cost check against your specific medication list. Bring your current drug list, your providers’ names, and a general sense of your recent tax-year income if IRMAA might apply.

Start by visiting the Mountaintop Insurance Medicare page to see how a consultation works, or explore how Medicare Advantage plans are actually structured before your appointment so you walk in with sharper questions.

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

Sources

FAQ

How Much Will My Medicare Advantage Plan Cost in 2026?

You’ll pay the standard $202.90 monthly Part B premium regardless of plan choice, plus your plan’s supplemental premium, which is $0 for about 75% of enrollees and averages around $14 for the rest. Your total annual cost depends far more on your plan’s out-of-pocket maximum and how much care you use than on the premium alone.

What Are Five Things Medicare Advantage Typically Doesn’t Cover in 2026?

Most Medicare Advantage plans limit or exclude routine long-term custodial care, cosmetic procedures, most care received outside the U.S., services from out-of-network providers without prior authorization (especially on HMOs), and certain experimental treatments not covered by Original Medicare. Exact exclusions vary by plan, so check each plan’s Evidence of Coverage document directly.

Is the Government Raising Medicare Premiums in 2026?

The standard Part B premium rose to $202.90 for 2026, consistent with the annual adjustments CMS makes based on projected program costs; this reflects the standard federal update process rather than a change tied to any single administration’s policy. Average Medicare Advantage supplemental premiums are actually projected to stay low, near $14 a month, for 2026.

What Are the Income Limits for Medicare Premiums in 2026?

IRMAA surcharges apply once your modified adjusted gross income from two years prior exceeds $109,000 for individuals or $218,000 for joint filers, with the total Part B premium rising in tiers up to $689.90 for the highest earners. The Social Security Administration sets and publishes these brackets each year and handles appeals for beneficiaries whose income has dropped since the tax year used for the calculation.

Disclaimer: This article is for general educational purposes only and does not constitute personalized advice. Medicare rules and plan details change frequently.

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