Medicare Advantage plan costs

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  • In a Medicare Advantage plan (private health plan) you generally must pay the Medicare Part B premium. Some Medicare Advantage plans may also charge you an additional premium. In some cases, the plan may pay part of your Part B premium.


  • Medicare Advantage plans may make you pay a deductible for doctor visits, but some do not. In addition, they may charge a deductible for hospital visits and prescription drugs.


  • Medicare Advantage plans usually charge you a copayment—a fixed dollar amount—when you visit a doctor, instead of the 20 percent coinsurance you pay under Original Medicare. 


  • All plans must include a limit on the amount of cost-sharing you will pay during the year. These limits include copays and deductibles. These limits may be high, but they will protect you from excessive out of pocket costs if you need a lot of care or expensive treatment. 


  • Medicare Advantage plans cannot charge higher copayments than Original Medicare for certain care. This includes chemotherapy, dialysis and durable medical equipment. They can charge you more than Original Medicare for others services, including home health, skilled nursing facility and inpatient hospital services.


  • Many Medicare Advantage plans have a network of doctors, hospitals and pharmacies, and provide services only in a certain part of the country. You will have to pay more for your health services if you get care outside of the plan’s network or service area.


  • Different plans have different rules for how and where you can get coverage. You may have to pay the full cost of services yourself if you do not follow your Medicare Advantage plan’s rules.

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