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Medicare Part C Costs -
Medicare Advantage Plans

What is the cost of a Medicare Advantage plan?

Each Medicare Advantage plan sets its own premium and cost-sharing terms.

Plans are required to limit the amount you may have to pay out-of-pocket each year. The limit may vary by plan.

You can get specific information about plans you’re interested in from the companies offering them.

Medicare Advantage Costs

Premium A fixed amount you have to pay to participate in a plan or program, usually as a monthly payment.

  • Premiums for Medicare Advantage plans can vary widely. You continue to pay your Medicare Part B premium to Medicare (and your Part A premium, if you have one).

Deductible A pre-set, fixed amount that you pay for your medical care and services first, before Medicare or other insurance starts to pay.

  • Some plans charge an annual deductible, and some don’t.

Copayment A pre-set, fixed amount that you pay for a service at the time you receive it. In a Medicare Part D plan, for example, you might pay a $7 copayment for each prescription you fill. Also called a “copay.”

  • Many plans charge copayments for the services and benefits you use.

Coinsurance A percentage of the cost for a service, which you split with your plan. For example, Medicare Part B might pay 80% of the cost of a medical service and you would pay 20%.

  • Plans set their own coinsurance terms and percentages.

How does Medicare Advantage cost sharing work?

Cost-sharing terms and amounts vary from plan to plan. You’ll need to shop around for a plan that best fits your needs.

Here are some examples.

Michael’s story: Coordinated care in-network office visit

Maria’s story: Brief hospital stay

William’s story: Long hospital stay

Michael Maria William

Michael’s story: Coordinated care in-network office visit

Michael has a coordinated care Health
Maintenance Organization (HMO) plan.
He visits an in-network doctor.

Office visit$100

Copay for office visit$10

Total Michael pays $10

Maria’s story: Brief hospital stay

Maria stays in the hospital three days, goes
home for a week, and then spends four more
days in the hospital. Her coordinated care plan
has a $150 copay for each day of a hospital stay.

Days 1 to 3 copays for first stay $450

Days 1 to 4 copays for second stay$600

Total Maria pays $1.050

William’s story: Long hospital stay

William stays in the hospital 185 days. His coordinated care plan applies a $150 per day copay for each day of a hospital stay and puts a $3,000 maximum, or cap, on out-of-pocket spending.

Days 1 to 20 (20 days at $150 per day) $3,000

Day 21 to 185 (after the cap is reached) $0

Total William pays $3,000

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