What is the cost of a Medicare Advantage plan?
Most Medicare Advantage plans use a combination of deductibles, co-insurance and co-payments 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.
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 monthly 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 co-payments for the services and benefits you use.
- Medicare Advantage plans set their own co-insurance terms and percentages. Some services may require co-insurance instead of a co-payment.
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 2015, 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 2015 would be your $1,260 deductible. With a Medicare Advantage plan, you might pay a $150 per day co-pay for each day in the hospital. This is just an example. 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 patient stories that show how cost sharing might work in different situations. The amounts shown are only for illustration purposes. Your actual costs may be different.
Michael’s story: Coordinated care in-network office visit
Maria’s story: Brief hospital stay
William’s story: Long hospital stay