Costs

With Medicare Advantage, each insurance company has the option to price its plans differently, although all Medicare Advantage plans must offer at least the same amount of coverage as Original Medicare (Part A & Part B).

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.

Noted earlier, the 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 covers 100% of covered medical services for the rest of the year. With Medicare Advantage plans, you have peace of mind knowing that there’s a cap to your annual medical costs.

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. Premiums can range from $0 and up depending on your plan. 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 co-payments, coinsurance, or deductibles required by the Medicare Advantage plan.

• 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.

Plan Renewal

Advantage enrollees can stay in the plan until they choose to disenroll or if the plan changes.

Figures

Over 11 million enrolless each year since 2010.