Health Conditions Discover Plan Connect. Medically reviewed by Shilpa Amin, M. Out-of-pocket costs Medicare Advantage plans Eligibility Takeaway Medicare Advantage plans are all-in-one alternatives to original Medicare offered by private companies.
Individuals The company offering the Medicare Advantage plan charges you out-of-pocket costs. These costs vary by company and plan offerings. What factors affect your costs for a Medicare Advantage plan? What are Medicare Advantage plans? Am I eligible for Medicare Advantage plans? The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products.
Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance. Read this next. Original Medicare vs. Medicare Advantage. Premium payments also help fund the Medicare Advantage plans. In addition, most insurance companies also charge MA subscribers an additional monthly premium, but the amount varies with the plan and insurance company.
Medicare Advantage subscribers also pay part of the expenses through cost sharing. Each MA plan is different, but many of them charge one or more yearly deductibles. A deductible is the amount you must pay before your insurance covers a particular type of expense, such as a hospital bill.
After the deductible, you'll generally have to pay a certain percentage of the remaining amount, called coinsurance. Most MA plans also charge a fixed amount for goods and services that aren't subject to a deductible. In addition to the Part B premium, which you must continue to pay when you enroll in Medicare Advantage, some Medicare Advantage plans also charge a separate monthly premium.
The insurance company uses this pool of money from the Medicare Trust Funds plus any additional premiums paid by plan members to pay the covered health care expenses for everyone enrolled in a particular plan.
Claims for people enrolled in Medicare Advantage are paid by the insurance company and not by the Medicare program as they are for those enrolled in Original Medicare. Many plans require you to get care from network providers or get prior authorization for any expensive tests and procedures.
In return, however, Medicare Advantage plans tend to have lower out-of-pocket costs than Original Medicare, and unlike Original Medicare, Medicare Advantage plans also have annual limits on what you have to pay out-of-pocket before the plan covers all your costs. Many Medicare Advantage plans also include Part D coverage for prescription drugs so you can get all your Medicare benefits in one convenient plan. Although the Medicare funding is the same for all insurance companies offering Medicare Advantage plans, each company chooses what types of plans and benefits it will offer.
No matter what company and plan type you select, however, you are still entitled to all the same rights and protections you have under Original Medicare. You may be able to enroll in a zero-premium Medicare Advantage plan although, remember, you still have to pay your regular Part B premium and you may have other costs, such as copayments and coinsurance.
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