Some Medicare Advantage plans may have lower out-of-pocket expenses than Original Medicare, and some have a monthly premium of $ 0. Here are some questions to consider before purchasing a plan.
- Does the plan have a monthly premium?
- Many have a $ 0 bonus.
- Some pay your Part B premium.
- If you choose a plan with a premium, the premium will be paid separately from your Part B premium of $ 148.50 (the amount for 2021).
- Does the plan have an annual or additional deductible?
- How much is the co-payment for each visit or service?
- What kind of health services do you need and how often do you get them?
- Does your service provider accept Medicare?
- What is the plan’s annual limit for personal expenses?
Once you are enrolled in a Medicare Advantage plan, it becomes your primary insurance. The company takes care of the payment of all your claims. And each year, the cost of your plan will likely change. The plan provider (rather than Medicare) sets the amounts billed for premiums, deductibles, and services. An Annual Notice of Change (ANOC) is mailed to you each September to take effect on January 1.
Factors such as location play a major role in determining the cost of a Medicare Advantage plan. Costs are generally lower when using providers in your plan’s network and service area. To find the specific cost of a Medicare Advantage plan in your zip code, visit Medicare.gov.
The following example shows how package prices can vary significantly depending on location. Note: Your costs may differ from these ranges even if you live nearby but not in one of these areas, as rates are set by zip code.
Annual Medicare Advantage Plan Prices by Location
Most Medicare drug plans have a coverage gap called a “donut hole,” which means there is a temporary limit to what the drug plan will cover. “A person gets limited coverage when they are in the ‘donut hole’. whether as part of a Medicare Advantage plan or a separate Part D plan, ”explains Antinea Martin-Alexander, founder of Advocate Insurance Group in South Carolina. “The individual will not pay more than 25% of the cost of the drug into the donut hole until a total of $ 6,550 in personal expenses is reached. There are a number of things that contribute to out-of-pocket expenses while you’re in the donut hole: any annual drug deductible you may have, the co-payment for all your drugs, the manufacturer’s discount on that drug, and what the insurance company pays for this drug, ”she said.