How much does Medicare Advantage (Part C) cost?
What is my cost share with my Medicare Advantage plan?
Medicare Advantage (Part C) plans often have a low or $0 monthly premium. That sounds like a good deal when you’re on a budget. However, you'll still be responsible for a number of expenses. Make sure you understand what the total cost could be and how it relates to the coverage you receive.
A monthly premium is the fee you pay to the plan in exchange for coverage. Each Medicare Advantage (Part C) plan has a set monthly premium. Some plans have a low or even $0 monthly premium.
An annual deductible is the amount you pay out-of-pocket for your health care before your plan begins to pay. It's a pre-set, fixed cost. Most Medicare Advantage plans have a separate medical and prescription drug deductible.
A copayment (also known as a copay) is a kind of cost sharing. You pay a predictable, pre-set amount for a covered medical service. For example, some plans might charge a $30 copay every time you see your doctor.
Coinsurance is a percentage of the total cost you pay for a covered medical service. Your plan pays the remaining amount owed. For example, your plan might pay 75% and your share would be 25%.
Medicare Advantage plans have a limit on how much you have to pay every year. Once you reach the annual limit — known as an out-of-pocket maximum — you pay nothing more for covered expenses for the rest of the plan year.
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Are there other Medicare Advantage costs to consider?
While extra coverage may mean an additional cost up front, it could save you money in the long run. When comparing plans, consider the following items:
Most Medicare Advantage plans include prescription drug coverage. This is known as an MAPD plan. In fact, the monthly premium for an MAPD plan is often less than a prescription drug plan alone. Check the plan's drug list (formulary) to make sure your prescriptions are covered and find out how much they'll cost.
How to manage your Medicare Advantage plan costs
Each Medicare Advantage plan sets its own specific costs. When you compare them, consider the premium, deductible, copay and coinsurance to get an idea of your total out-of-pocket expenses.
Can I get help paying for my Medicare Advantage plan?
If you want the added benefits of a Medicare Advantage plan, but need help covering the costs, there may be help for you. Medicare Special Needs plans (SNPs) are Medicare Advantage plans for people who are eligible for Medicare and have certain financial or healthcare needs.
Features and benefits of Special Needs plans
Eligibility for a SNP is based on qualifications set by federal law. Each SNP offers benefits that go beyond Original Medicare. SNPs offer the following:
- Benefits specific to a condition, disease or living situation
- Always include prescription drug coverage
- May offer additional benefits, similar to Medicare Advantage plans
Special Needs plan types
There are different types of Special Needs plans. All offer specialized benefits:
- Dual-Eligible Special Needs plans (D-SNPs)
You have both Medicare and Medicaid (called "dual eligible").
- Chronic Special Needs plans (C-SNPs)
You live with severe or disabling chronic conditions.
- Institutional Special Needs plans (I-SNPs)
You live in a skilled nursing facility.
A person who lives in a contracted assisted living facility and needs the same kind of care as those who live in a skilled nursing facility may qualify for an Institutional-Equivalent Special Needs plan (IE-SNP). This is a special type of I-SNP.
How to manage your Medicare Advantage plan costs
Each Medicare Advantage plan sets its own specific costs. To compare them, start by looking for plan benefits that meet your needs. Consider the premium, deductible, copay and coinsurance to get an idea of your total out-of-pocket expenses. Staying in-network can often help you save. Also, check to see if you qualify for discount programs.
Additional Medicare Advantage plan resources
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