Out-of-Pocket Expenses in a Medicare Advantage Plan

A Medicare Advantage Plan is a privately run health plan, owned by private insurance companies, approved by (and working with) Medicare.  Medicare advantage plans, called MAs, or Part C, are required to follow rules set by Medicare and, in addition to your payments and fees, receive funding from Medicare.  

MA plans will provide beneficiaries with their Hospital Insurance (Part A) and Medical Insurance (Part B), all medically-necessary services covered by Original Medicare, and, in many cases, optional extra benefits such as vision, dental, hearing, and prescription drug coverage – for additional cost, of course.

In fact, many of your out-of-pocket costs in a Medicare Advantage Plan will vary significantly.  For instance, many MA plans will charge, on top of your Part B premium, another monthly premium.  Your costs will also vary depending on whether or not your MA plan has a yearly deductible or any other deductibles for certain health care services.  Costs can increase if your plan requires you to pay more for each doctor’s visit or health care service.  If you frequently require health care or if you need more costly services, this can also increase your out-of-pocket costs.  If you decide you want extra benefits, you can expect to pay more for these as well.   

There are, of course, some ways to reduce costs.  First – and perhaps most importantly – research available plans carefully.  Contact Medicare, at www.medicare.gov or at 1-800-MEDICARE – or call your local SHIP to find out more. Once you’ve selected a plan, be sure to familiarize yourself with your MA plan’s rules, and to follow them vigilantly. 

The right MA plan can allow you to receive the medical coverage you need.  However, unexpected costs can put a strain on your budget and, in some cases, even make receiving the care you need a significant hardship.  An awareness of the out-of-pocket costs involved in your Medicare Advantage plan can help you prepare for those expenses, and allow you to financially arrange for your future.