want to know What You Pay in a Medicare Advantage Plan? then checkout details below. Medicare advantages may offer more benefits than original medicare given by private insurance companies.  Medicare advantage plan covers both medicare part A and B coverage with some extra benefits. Instead of this, it has very low out-of-pocket costs compared to original medicare which may vary from plan to plan. But still, it has some out-of-pocket costs, that some of which are monthly premiums or some of them are yearly packages. 

Out of pocket costs of Medicare Advantage (part C) premiums:-

Premium is an amount of money that you need to pay when you are covered by health insurance but it may vary for the services of the plans. 

As an example, some of the premiums cost too high like $104 per month but some of the plans charge just $50 as a premium. There are also some premiums available that are too low at just $0 per month. 

If you have a premium of both part B and part C, then you need to pay both of the premiums as well as you can enjoy both of them. 

Out of pocket costs of Medicare part C (copayments/coinsurance):-

Copayments are a bunch of amounts that you need to pay when you enjoy the services of the medicare advantage plan.

On other hand, coinsurance is the percentage of the packages that you may pay after enrollment for the plan. 

The amount of both of them may vary from plan to plan. The amount of the copayments and coinsurance are also different from the original medicare which is the combination of medicare part A and B. Services provided when you pay both of these along with medicare advantage are mentioned below:- 

  • A visit to a specialist
  • An emergency room visit
  • An ambulance ride
  • A visit to a primary care doctor
  • An MRI or CT scan
  • Inpatient hospital days
  • Days in a skilled nursing facility
  • Outpatient surgery
  • Outpatient rehabilitation
  • Dental services
  • Eyeglass lenses
  • Prescription drugs
  • And more

You can see the value of the copayments and coinsurance before enrolling yourself in the plan. You can also compare yourself to the other plans. 

Out of pocket costs of medicare part C that is deductibles

Deductibles are the amount which you need to pay before your services start. Some of the Medicare plans have separate deductibles for prescription drugs and medical services and some of them are covered both. There are lots of medicare advantage plans that have $0 deductibles and $0 premiums. 

The out-of-pocket maximum for a medicare advantage plan

All the Medicare advantage plans have out-of-pocket maximums except original medicare. It may vary from plan to plan although it grows higher and higher every year. Out-of-pocket maximums are one of the reassuring amounts that pay before the medical services begin. 

For example, if you have a surgery that costs $10,000 then out-of-pocket you need to pay just $3000 or less before the surgery. If you have enjoyed other services then the amount remains lower. know more about Initial Enrollment Period.

Other things that might affect Medicare Advantage out of pocket costs

Generally, Medicare Advantage plans are offered by the managed care plan like Preferred Provider Organization (PPO*) or Health Maintenance Organization (HMO). These plans have a network of providers and doctors. HMOs are provided only networked services and PPO provides both in and out network services. Out-network services charge more than others. 

Medicare supplement plans are totally free for any types of out-of-pocket costs like deductibles, copayments, and coinsurance. But you can associate this only with original medicare.