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Medicare provides a wide range of coverage for health care services and prescription drugs, but it does not always pay 100% of costs. Before enrolling in a Medicare Advantage (Part C) health plan, be sure to check for out-of-pocket costs such as premiums, deductibles, and copayments. Here’s what you can expect to pay out of pocket throughout the year if you’re enrolled in a Medicare Advantage plan.
Medicare Advantage (Part C) out-of-pocket 2024 costs
Part C Premium |
Can vary from $0 to $200+ (estimated average monthly MA plan premium for 2024 is $18.50) |
|---|---|
Medicare Part C Deductible |
Varies, typically just Part B and prescription drug coverage deductible |
Copayments/Coinsurance* |
Varies depending on plan and service(s) received. Maximum out-of-pocket spending limit is $8,850 |
*Copayments may be required for doctors’ visits, specialist visits, labs, etc.
Premiums
A premium is the amount you pay each month to keep your Medicare Advantage plan in force. This cost may vary widely. Some plan premiums are $0, while other plans could have premiums over $200.
To join a Medicare Advantage plan, you must also be enrolled in Medicare Parts A and B (“original Medicare”). Part B has a separate premium you must pay even if you enroll in a Medicare Advantage plan. You may pay more if you delayed enrolling into Medicare Part B and have a penalty, have higher income, and/or have less than 40 Social Security work credits.
Deductibles
A deductible is a fixed amount you pay out of your own pocket before your health plan benefits kick in. Only some Medicare Advantage plans have an annual medical deductible. However, many Medicare Advantage plans that include Medicare Part D may charge another deductible for drug coverage.
Copayments/Coinsurance
Copayments and coinsurance are the portion of costs you pay for covered drugs or services like doctor visits. The amount varies, but copayments are usually a flat fee while coinsurance is a percentage of the total cost. For example, a 25% coinsurance means you are responsible for 25% of the cost while the plan covers 75%. Keep in mind plans often charge higher copayment and coinsurance amounts for visits to out-of-network providers.
Maximum out-of-pocket costs
Out-of-pocket costs (premiums, deductibles, and copayments) vary with each Medicare Advantage plan and can change every year. However, the maximum out-of-pocket spending limit is consistent for all plans. For 2024, the most you will spend out of pocket is $8,850. The spending threshold for plans that allow you to see out-of-network providers may be higher. If your Medicare Advantage plan also includes Part D prescription drug coverage, those costs will not count toward your out-of-pocket maximum.
Additional things to consider
- If you’re enrolled in an HMO (health maintenance organization) plan, you’ll need a referral from your primary care physician to visit a specialist. There will be a separate copayment for that appointment.
- If you’re enrolled in an HMO plan, be sure that any specialist you see refers you to an in-network lab or testing facility.
- If you’re enrolled in a Special Needs Plan (SNP), most of your out-of-pocket costs will be covered by Medicare and Medicaid.
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