By My
Medicare Matters® Team | 4.11.2019
Enrolling in a Medicare plan is a big decision. While you’re
able to switch plans each year if you’re unhappy (in some
situations more frequently) you still want to choose the best plan for
your needs the first time. This means taking your out-of-pocket costs into consideration along with other factors. Medicare covers a wide range of medical
services, but most are not free. Here’s what you should expect to pay
out-of-pocket throughout the year if you’re enrolled in a Medicare Advantage/Part C plan.
Premiums
Premiums are the amount you pay each month out-of-pocket for
your Medicare Advantage (MA) plan. The estimated average monthly MA
plan premium for 2019 is $28, this cost may vary significantly. Some
could be $0, while others could have premiums over $200.
To join an MA plan, you must also be enrolled in Medicare Parts A & B. It’s important to remember
that Part B has a separate premium that you are responsible for paying even if you
enroll in a Medicare Advantage/Part C plan. The standard Part B premiums in
2019 is $135.50. per month. You may pay more if you delayed enrolling
into Medicare Part B and have a penalty, have higher income, and/or have
under 40 Social Security work credits.
Deductibles
A deductible is the amount paid out of pocket by
a beneficiary or insured individual before benefits begin. Only some
Medicare Advantage plans have an annual medical deductible. However, many
Medicare Advantage plans that include Part D/prescription drug coverage may charge
another deductible for drug coverage.
Copayments/Coinsurance
Copayment/Coinsurance are the portion of cost you pay for
covered drugs or service like doctors’ visits, also referred to as
cost-sharing. The amount varies, but copays are usually a flat fee while
coinsurance is not a fixed dollar amount. Instead, it is a percentage of the
cost of the item/service that the patient must pay. For example, a 25%
coinsurance means that the patient is responsible for 25% of cost while the
plan covers 75% of the cost. Keep in mind that plans often charge higher copay
and co-insurance amounts for out-of-network providers.
Maximum Out-of-Pocket Costs
These out-of-pocket costs (premiums, deductibles, and
copayment) vary in each MA plan and can change every year, but the maximum out-of-pocket spending limit is consistent for all
plans. For 2019 the max you will spend is $6,700, this amount changes every
year. The out-of-pocket maximum for plans that allow you to see out of network
providers may be higher. If your Medicare Advantage plan includes
prescription drug coverage you will have a separate out-of-pocket maximum for
prescription drug costs.
Additional Considerations
- If
you’re enrolled in an HMO, you’ll need a referral from your primary care
physician to visit a specialist and there is a separate copay for that
appointment.
- If you’re enrolled in an HMO, 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 are typically covered by Medicare and Medicaid.
There are lots of considerations when choosing a Medicare plan,
which is why it’s important to look at the 4 Cs when making a decision. Don’t hesitate to speak
with a Medicare expert about your options.
About My Medicare Matters® Team
MyMedicareMatters.org is brought to you by the National Council
on Aging (NCOA) in partnership with Aon Retiree Health Exchange™ and Via
Benefits™. This educational service is designed to make it easier for people
with Medicare (and those turning 65) to make informed and confident choices
about their health coverage and to make the most of that coverage.
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