What You Pay in a Medicare Advantage Plan?

May 31st, 2017     Medicare

Medicare Advantage Plans provide extra benefits in comparison to Original Medicare (Part A & Part B) and may also have lower out-of-pocket costs. The health insurance premium and out-of-pocket costs will be based on the chosen Medicare Advantage plan and are usually paid on montly basis. Other costs included are co-payments for doctors’ consultation and other healthcare services, and premiums for optional benefits, such as vision, hearing, dental and prescription drugs coverage .

Medicare Part B and Medicare Advantage Premiums

The person has to continue to pay for Medicare Part B premium even if he is enrolled in a Medicare Advantage plan. Medicare Part B premiums must be paid directly to Medicare. The monthly cost may increase based on the patient’s annual household income from two years prior.

In addition to the Medicare Part B premium, Medicare Advantage plans often charge a monthly premium for coverage. $0 premium medicare advantage plans are also available.

Annual deductibles in Medicare Advantage Plans

Health insurance premium depend on the plan’s annual deductible. Few Medicare Advantage plans should meet an annual deductible before coinsurance comes into play. These deductibles vary by plan, with higher annual deductibles often indicate lower monthly plan premiums.

The person should compare and choose wisely between plans with higher monthly premium and plans with higher annual deductible in order to save his Medicare costs. For Example, if the person is ill, a plan with a higher monthly premium and a lower annual deductible may save his most money in long run. He should also consider the plan’s Maximum Out-of-Pocket (MOOP) amount. Once he reaches this spending limit, the Medicare Advantage plan covers 100% of the cost. So choosing a plan with a low MOOP limit reduces his Medicare costs.

Co-payments in Medicare Advantage plans

Medicare Advantage co-payments vary extremely among plans. Few plans have co-payments for doctors’ visits, hospital stays, ambulance rides and emergency room visits. Co-payments are figured on a two or three tier system. For Example, a primary care physician’s visit may have lower co-payment (say $10 per visit) than a specialist’s visit (say $20 per visit). Emergency care co-payments are expensive.

Prescription drug costs in Medicare Advantage plan

Medicare Advantage plans with prescription drug coverage will have a formulary, which is a list of covered prescriptions. The formulary structures prescriptions into tiers, with generic ones located in the lowest tier. The lowest tiered ones are typically cheaper than the ones located in the highest tier.




Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.