Almost a third of Medicare beneficiaries receive their coverage through Medicare Advantage (MA), also called Part C. If you enroll in an MA plan, you still have Original Medicare, and you’re still responsible for paying your Part B premium. But there are other costs to consider too, such as deductibles, copayments, and maybe even a monthly premium for your MA plan. If you’re considering your options and would like an idea of what to expect for Medicare Advantage plan costs, here’s a quick breakdown.
Some Plans Charge a Monthly Premium
Luckily, there are many plans to choose from, with just as many premium amounts. Some plans offer low, even zero monthly premiums for coverage, while others can charge as much as $150 per month. Generally, with Medicare Advantage, you still need to pay your Part B premium in addition to any premium amount charged by your MA plan.
Deductibles, Coinsurance and Copays
Out-of-pocket costs vary with Medicare Advantage. Some plans require that you pay a deductible for doctor or hospital visits, while others do not. However, most plans do charge you a copayment each time you visit the doctor. This is in place of the 20 percent coinsurance you would be required to pay under Original Medicare. The good news is, that all Medicare Advantage plans are required by law to put a limit on the amount of money you will need to spend out-of-pocket for deductibles and copays for coverage each year.
Out of Network Charges
Unlike Original Medicare where you can receive care in any facility that accepts Medicare, with an MA plan, there are specific networks of providers. As a member of the plan, you agree to use the hospitals, doctors, and pharmacies that are in the plan’s network for your care. You can use providers who are not in the plan’s network or service area but it will cost you more. It’s important to read and understand your plan’s rules. If you don’t, you may be responsible for the full costs of medical services.
In Summary
Your out-of-pocket costs for Medicare Advantage are based on answers to the following questions:
How much is the plan’s monthly premium?
Does the plan pay for any of your Part B premiums?
Is there a yearly deductible?
How much will you have to pay for each visit or service? (copays and coinsurance)
Will you pay more for care received out of the plan’s network?
What is the plan’s yearly limit for out-of-pocket costs for all medical services?
References:
https://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html
MUC60-2017-BCBS
