Plans that offer additional coverage such as routine vision, dental, and prescription drug coverage may be more likely to charge higher out-of-pocket costs. Certain types of Medicare Advantage plans, such as Health Maintenance Organization (HMO) plans, may require that beneficiaries use in-network providers, or they will not cover the costs of services, with the exception of medical emergencies. In general, Medicare Advantage plans have lower cost sharing than Original Medicare, but specific Medicare Part C costs will depend on the plan.
One notable difference between Medicare Part C and Original Medicare is that all Medicare Advantage plans have a yearly out-of-pocket spending limit. Once you reach the plan limit (including the deductible), the Medicare Advantage plan overs 100% of covered medical services for the rest of the year. In contrast, Original Medicare doesn’t have an annual spending cap, and there’s no maximum limit on the amount you could spend on health-care services in a given year. If you get into a serious accident or have an illness that requires a lot of ongoing care, your health-care costs could quickly skyrocket.
With Medicare Advantage plans, you have peace of mind knowing that there’s a cap to your annual medical costs.
Medicare Advantage Plan Premiums
- Be enrolled in both Medicare Part A and Part B.
- Live in the service area of a Medicare Advantage plan.
- Not have an end-stage renal disease (with some exceptions).
For most individuals, Medicare Part A is premium-free if you have worked at least 10 years (40 quarters) and paid Medicare taxes; otherwise, you may owe a monthly premium. Medicare Part B generally includes monthly premiums unless you qualify for low-income assistance.
In addition to paying your Part B premium, you may also be responsible for paying a Medicare Advantage premium. Some Medicare Advantage plans may have premiums as low as $0, while other plans may have higher monthly premiums, You may want to compare all available plan options in your area to find a plan with costs and benefits that meet your needs. Remember, even if your service area offers a Medicare Advantage plan with a $0 premium, this doesn’t mean that that plan won’t have other costs. You’ll still need to pay the Medicare Part B premium, along with any copayments, coinsurance, or deductibles required by the Medicare Advantage plan. Always be careful to evaluate all costs related to any Medicare Advantage plan you’re considering, not just the premium.
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Other Medicare Advantage Plan Costs
The cost of your Medicare Advantage plan will depend on a variety of factors, including:
- How much you pay for each service or doctor visit (copayment and/or coinsurance).
- Whether the plan has a yearly deductible that you must meet before it provides coverage.
- What type of services you require and how often you require them.
- Whether you enroll in a plan with additional benefits such as routine vision, dental, or prescription drug coverage.
- Your out-of-pocket prescription drug costs (if the plan includes this benefit)
- How much the plan’s maximum out-of-pocket limit is for covered medical services.
- Whether you will be required to receive care from in-network health-care providers or whether you can use non-network providers (usually with higher cost sharing).
- Medicare Advantage plans determine cost-sharing requirements for covered services, and each plan sets its own coinsurance percentages and terms. So it’s a good idea to shop around and compare plan options to find coverage that fits your budget and offers the best value.
Keep in mind that Medicare Advantage plan costs may change from year to year, so it’s important to review your coverage annually to make sure it’s still meeting your needs.
If you need help finding Medicare Advantage plan options that fit your budget, contact eHealth to speak with a licensed insurance agent today.