Medicare Advantage plans can have deductibles, copayments and coinsurance that vary by plan and by the healthcare services you use.
Every Medicare Advantage plan has an annual limit on what you pay out of pocket for covered Medicare Part A and Part B services.
Once you reach your plan’s applicable annual limit, the plan pays 100% of covered Medicare Part A and Part B services for the rest of the calendar year.
Your actual limit and costs depend on your specific plan.
Generally, your cost sharing for covered Medicare Part A and Part B services counts toward the plan’s applicable medical out-of-pocket maximum.
This can include certain:
Your plan’s Evidence of Coverage explains exactly what counts.
Part D prescription drug costs don’t generally count toward your Medicare Advantage medical out-of-pocket maximum.
Drug costs follow Medicare Part D rules instead.
Common Medicare Advantage Costs
Depending on the plan, you may pay for:
Primary care visits
Specialist visits
Emergency-room care
Ambulance services
Outpatient surgery
Diagnostic imaging
Physical therapy
Hospital stays
Durable medical equipment
Actual amounts vary considerably among plans.
Network Costs
PPO plans may allow out-of-network care, but your share can be higher.
HMO plans generally require you to receive non-emergency care inside the network, subject to plan rules.
How Much Can Medicare Advantage Really Cost?
A $0 premium doesn’t mean $0 healthcare costs.
That’s probably the most important point on this page.
I want people comparing Medicare Advantage plans to look past the monthly premium and ask:
What do I pay if I’m hospitalized?
What does a specialist cost?
What about chemotherapy, imaging or outpatient surgery?
What is my annual maximum exposure?
A healthy year can look inexpensive.
The real test is what the plan could cost during a bad health year.
Medicare Advantage plans cover Medicare-covered cancer treatment, including qualifying chemotherapy, but plan networks, prior authorization rules and out-of-pocket costs can become especially important when someone has cancer.
Medicare’s Annual Enrollment Period, also commonly called Medicare Open Enrollment, runs, October 15 through December 7 each year.
