Medicare Advantage Copays and Deductibles in 2027

Amounts vary by plan and county. Check each plan’s Summary of Benefits for the exact 2027 cost-sharing.

HMOs usually have lower copays than PPOs but cover only in-network care, except emergencies and urgent care. PPOs let you go out of network, but out-of-network copays and coinsurance are higher, and PPOs often have a separate, higher combined out-of-pocket limit.

Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered Part A and Part B services. Once your copays and coinsurance reach that limit, the plan pays 100% of covered in-network care for the rest of the calendar year. Premiums and drug costs do not count toward it.

Drug costs work separately. Your plan may have a drug deductible up to $700, then copays or coinsurance by tier. Once your out-of-pocket drug spending reaches $2,400, you pay nothing more for covered drugs for the rest of 2027.

For a true cost comparison, price out two years for every plan: an easy year with a handful of doctor visits plus your drugs, and a rough year in which you hit the out-of-pocket maximum. In a bad year, a $0 premium plan with a high maximum can end up costing much more than a plan with a modest premium and a lower maximum.

Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.

The trade-off is that Medicare Advantage plans generally rely on doctor and hospital networks and may call for referrals or prior authorization for certain services. Each Medicare Advantage plan sets a yearly out-of-pocket maximum for covered medical care, something Original Medicare lacks. You still pay your Part B premium, along with the plan’s premium if there is one.

A non-renewal notice should have reached you in early October if your plan won’t be available in your county for 2027. Coverage doesn’t end immediately; it runs through December 31, 2026, which gives you time to decide.

When your income and savings are limited, two programs can greatly lower your Medicare costs:

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

The Annual Notice of Change must reach members by September 30. It is the most useful single document you receive each fall, since it spells out exactly how your plan will change on January 1.

You do not need to compare plans by yourself, and help should not cost you anything. Here are the free options:

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.