What will you pay for Medicare Advantage?
Most Medicare Advantage plans use a combination of deductibles, coinsurance and copayments to share costs with you. These cost-sharing arrangements will usually apply to all of the services the plan covers—hospital stays, doctor visits, drug coverage if you have it and so on.
The company that offers the plan sets the premium, if any, and decides on the cost sharing. You need to look at the details of each plan you’re considering to fully understand the costs. You can get specific information about plans you’re interested in from the companies offering them.
Keep reading for more information
Medicare Advantage Costs
- You continue to pay your Medicare Part B premium to Medicare (and your Part A premium, if you have one). Plans may or may not charge a separate premium that you pay to the plan. Premiums for Medicare Advantage plans can vary widely.
- Some plans charge an annual deductible, and some don’t.
- Many plans charge copayments for the services and benefits you use.
- Medicare Advantage plans set their own coinsurance terms and percentages. Some services may require coinsurance instead of a copayment.
All Medicare Advantage plans are required to protect you from high cost sharing by limiting the amount you may have to pay out-of-pocket for Part A and Part B services each year. In 2013, the limit is $6,700 for the year, not counting premiums or drug costs. Plans can set a lower limit, but no plan can ask you to pay more for these covered services.
Keep in mind, there is no out-of-pocket maximum limit with Original Medicare (Part A and Part B).
How does Medicare Advantage cost sharing work?
You will need to investigate the details of each plan to get the full story on its cost sharing. Plans vary widely, and their cost sharing usually works quite differently from the cost sharing used in Original Medicare (Parts A and B).
For example, under Medicare Part A, your cost sharing for a five-day hospital stay in 2013 would be your $1,184 deductible. With a Medicare Advantage plan, you might pay a $150 per day copay for each day in the hospital. This is just an example. Each plan may vary.
Medicare Advantage plans that include drug coverage generally share costs with members in much the same way that standalone Medicare Part D prescription drug plans do. See Medicare Prescription Drug Coverage Costs for more information about this.
Cost-sharing terms and amounts vary from plan to plan. When researching Medicare costs, you’ll need to shop around for a plan that best fits your needs. Here are some examples. The amounts shown are only for illustration purposes. Your actual costs may be different.