Medicare Advantage plans must cover all the services that Original Medicare covers, however there are some differences in how they are covered.
What are MA Plans Out of Pocket Maximums?
Medicare Advantage plans are not standardized, so each plan may vary their out of pocket limits. With that said, legally they max out at as high as $8850 each year. It should be noted that copays generally don’t count toward out of pocket costs.
How much will an MA Plan Cost for Hospitalization?
Not to sound like we aren’t giving you a direct answer, but due to the lack of standardization, Medicare Advantage plans will vary their coinsurance, deductibles, and copays when it comes to hospitalization. What we have discovered is some plans don’t have any deductible or coinsurance for hospitalization, while others do. As well as, some plans do not put a limit on the number of hospitalization days like Original Medicare does (hospitalization days max out at 90 days per year with 60 lifetime reserve days –Medigap extends these days ). It is important when looking at plans to weigh how the plan covers all costs.
How to Pick a Medicare Advantage Plan
As we discussed plans vary greatly by provider, so you’ll have to really do your homework on these plans. The following are a few questions you should ask before choosing a plan:
- How much is the monthly premium?
- Is Rx included? If so, does it cover my prescriptions?
- How large is the network?
- What is the out-of-pocket maximum?
- What are the copays, deductible, and coinsurance for services?
- What are the limits on services?
- How many hospital days are allowed?
- Are there extras like dental, vision, and the Silver Sneakers program?
- Compare the coverage of Medigap to MA plans
One last noteworthy thing about Medicare Advantage
Congress is looking at ways to lower Medicare costs and it has been noted that Medicare Advantage costs Americans quite a bit more than Original Medicare. Congress is working to reduce these MA costs which may include increasing cost-sharing (deductibles, copays, coinsurance, and out of pocket maximums) in the years to come.
The good news is you can change your MA plan once a year during the Medicare Advantage open enrollment period. An agent can help answer these questions for you. Call the number above or contact Senior65.com for help with Medicare Advantage.