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Medicare Advantage Costs in Colorado: What $0 Premiums Hide in 2026

Colorado couple comparing Medicare plan costs

Most Medicare Advantage plans charge no extra monthly premium beyond what you already pay for Part B, but that $0 headline doesn’t mean $0 spending. You’ll still face copays, coinsurance, and possibly a separate Part D bill, though a yearly out-of-pocket ceiling caps your exposure on Part A and Part B services. Original Medicare paired with Medigap trades a higher, predictable premium for fewer surprises at the doctor’s office. Which route costs less in a given year depends on how much care you actually use.

TL;DR:

About 75% of Medicare Advantage enrollees with drug coverage pay no extra plan premium, but everyone still pays Part B and faces cost sharing.

For 2026, the in network cap is $9,250; certain PPOs set a combined limit up to $13,900, excluding drugs and Part B premiums.

Medicare Advantage tends to have lower average annual costs than Original Medicare with drug coverage, and lower still than Original Medicare with Medigap Plan G.

About 99% of Medicare Advantage enrollees face prior authorization for some services; Medigap Plan G or N costs more monthly but has no provider network.

Before enrolling, compare your prescriptions and doctors against each plan, check its exact out of pocket limit, and review prior authorization rules.

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Breaking Down What You Pay: Premiums, Copays, and Part D
Understanding Your Maximum Out-Of-Pocket Protection
How Medicare Advantage Stacks Up Against Original Medicare Plus Medigap
Comparing Plans During Open Enrollment: A Practical Checklist
Why Local Guidance Matters When Costs Get Complicated
Get Help Comparing Medicare Advantage Costs in Colorado
FAQ
Sources

Breaking Down What You Pay: Premiums, Copays, and Part D

Every Medicare Advantage enrollee pays the standard Part B premium to Medicare itself, regardless of which plan they choose. On top of that, the plan may or may not charge its own premium. In 2026, the enrollment-weighted average supplemental premium for MA plans that include drug coverage is about $15 a month, and roughly 75% of MA-PD enrollees are in plans that charge no additional premium at all.

That low headline number is only part of the picture. The real cost shows up in deductibles, copays, and coinsurance, which vary by plan and by service. You’ll find the specific dollar amounts in a plan’s Summary of Benefits and Evidence of Coverage documents, available through Medicare.

A few things to check before you assume a plan is cheap:

Primary care visits often carry a flat copay, while specialist visits and hospital stays typically cost more per encounter.
Prescription drug coverage under Part D runs on its own cost structure, with a separate deductible and coinsurance schedule.
Drug spending generally does not count toward your Medicare Advantage out-of-pocket maximum, so a year of expensive prescriptions can add real cost outside that cap.

Consider two simple scenarios. A relatively healthy enrollee who sees a primary care doctor twice a year and takes one generic medication might spend a few hundred dollars annually beyond the Part B premium. An enrollee managing a chronic condition with specialist visits, imaging, and several brand-name prescriptions could rack up thousands in copays, coinsurance, and Part D costs before hitting any cap, since that cap only applies to Part A and Part B charges.

Understanding Your Maximum Out-Of-Pocket Protection

Every Medicare Advantage plan is required to cap what you pay for Part A and Part B services each year. For 2026, CMS sets the in-network ceiling at $9,250, with a combined in-network and out-of-network ceiling of up to $13,900 for certain PPO plans. Most plans set their limits well below the maximum, with an enrollment-weighted average MOOP of about $5,421.

2026 Medicare Advantage out-of-pocket limits

Pro Tip: Ask for the plan’s exact MOOP number in writing, not just the premium, before you compare two plans side by side.

The out-of-pocket limit covers your cost sharing for hospital stays, doctor visits, and other Part A and Part B services. It does not include your Part B premium, and it typically excludes Part D drug costs and many supplemental benefits like dental or vision allowances.

Common missteps worth avoiding:

Treating the MOOP as a cap on every dollar you’ll spend, when prescriptions and extras often sit outside it.
Overlooking that PPO plans may have a separate, higher combined limit when you go out-of-network.
Assuming a low premium automatically means low total annual cost once copays and drug spending are added up.

How Medicare Advantage Stacks Up Against Original Medicare Plus Medigap

Independent cost comparisons, including analysis commissioned by UnitedHealth Group, have found that Medicare Advantage with drug coverage tends to produce a lower average annual beneficiary cost than Original Medicare paired with a standalone drug plan, and lower still than Original Medicare paired with Medigap Plan G. The gap comes from how each path spreads risk.

Medicare Advantage generally lowers your average annual spending and caps your worst-case exposure on Part A and B services, but it does so through provider networks and utilization management. Nearly all MA enrollees, about 99%, are in plans requiring prior authorization for at least some services in 2026, which can delay or complicate care. Medigap works differently: you pay a higher, steady premium every month, but once you’re past the Part B deductible, Plan G or Plan N leaves you with few surprise bills and no network to navigate.

Rebate dollars help explain why MA premiums stay low. CMS rebates to plans average nearly $2,400 per enrollee in 2026, funding the supplemental benefits and reduced premiums that make the plans attractive on paper.

A few questions help clarify which path fits:

How often do you expect to see doctors, specialists, or need procedures this year?
Do you need the flexibility to see providers nationwide, including when traveling?
Would a higher, predictable monthly premium feel easier to manage than variable copays?

If your situation is complex enough that you want help weighing these tradeoffs in detail, our comparison of Medicare Advantage vs. Medigap walks through the decision further.

Comparing Plans During Open Enrollment: A Practical Checklist

Shopping by premium alone is the single biggest reason people end up with a plan that costs more than expected. Here’s an order to work through:

Start at Medicare.gov’s Plan Finder to pull up every plan available in your ZIP code.
Confirm your Part B premium and any plan-level premium separately, since they’re billed differently.
Check the plan’s in-network MOOP, and for PPOs, the combined in/out-of-network MOOP.
Look up your current medications in the plan’s formulary to catch specialty-tier pricing.
Confirm your doctors and preferred hospital are in-network before you enroll.
Review which services require prior authorization and what supplemental benefits (dental, vision, hearing, transportation) actually include as annual dollar limits.

Pro Tip: Pull your prior year’s claims history before shopping. Knowing exactly what you used last year makes it far easier to estimate what a plan will actually cost you this year.

When you talk to an agent or plan representative, ask directly: Does this plan cover my current specialists? Are any of my medications in a high-cost tier? What exactly counts toward the out-of-pocket maximum? Is prior authorization required for any treatment I already have scheduled? Because plans and premiums change every year, it’s worth re-checking all of this during each Annual Enrollment Period rather than assuming last year’s plan still fits. If your income is limited, ask about Extra Help or your state’s Medicare Savings Programs, since both can reduce what you owe. For a broader primer on how these pieces fit together, our guide to Medicare costs covers the fundamentals in more depth, and brokers like Platinum Benefit Advisors offer similar plan-comparison guidance in other states.

Why Local Guidance Matters When Costs Get Complicated

Premiums and out-of-pocket math look straightforward until you’re juggling multiple prescriptions, several specialists, or a move between Colorado counties with different plan networks. That’s where independent, licensed guidance earns its keep. You can find personalized advice across multiple carriers, comparing plans against your actual health needs and financial goals rather than steering you toward one insurer’s product.

Ongoing involvement after enrollment, through annual plan reviews and help with claims, can help ensure a plan that fit your situation earlier doesn’t quietly become a bad fit as your prescriptions or providers change. For Castle Pines and Colorado residents managing chronic conditions, multiple doctors, or a recent move, that ongoing check-in often matters more than the sticker price on any single plan.

— Zach

Get Help Comparing Medicare Advantage Costs in Colorado

Figuring out your real annual cost, not just the advertised premium, is exactly what we help Colorado residents do every day. Services offered may include:

Medicare Advantage consultations that compare total expected costs across available plans
Plan G and Plan N quotes for those weighing Medigap against Medicare Advantage
Annual Enrollment Period reviews to catch changes before they cost you money

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If you’re in Castle Pines, Centennial, Denver, or elsewhere in Colorado and want a straight answer about what a specific plan will actually cost you, reach out through our Medicare Advantage plan page to schedule a free consultation.

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

FAQ

How much do Americans pay for Medicare?

Costs vary widely depending on whether someone chooses Original Medicare, Medicare Advantage, or adds a Medigap policy, since each path has a different premium and cost sharing structure. In 2026, the enrollment-weighted average supplemental premium for Medicare Advantage plans with drug coverage runs about $15 a month, on top of the standard Part B premium everyone pays.

What are the biggest mistakes people make with Medicare?

The most common mistake is comparing plans by premium alone and ignoring copays, coinsurance, and whether prescriptions or preferred doctors are covered. Another frequent error is assuming the out-of-pocket maximum caps all spending, when it typically excludes Part D drug costs and most supplemental benefits.

Can I switch back onto regular Medicare and cancel Medicare Advantage?

Yes, you can generally switch from Medicare Advantage back to Original Medicare during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. Keep in mind that picking up a Medigap policy afterward may involve medical underwriting outside your initial enrollment window, so timing matters.

Is it better to have Medicare Part B or Medicare Advantage?

These aren’t competing choices since Medicare Advantage still requires you to pay the Part B premium. The real decision is whether to stay on Original Medicare, potentially adding a Medigap policy for predictable costs, or enroll in a Medicare Advantage plan that often has a lower average annual cost but relies on provider networks and prior authorization.