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Learning About Car Insurance

The 4 Costs Associated With Medicare Advantage Healthcare Plans

by June Peterson

If you are thinking about enrolling in a Medicare Part C plan, also known as a Medicare Advantage plan, it is vital to understand the costs associated with this type of coverage. To select the most appropriate plan for yourself, you need to fully understand the cost that you face based on the plan that you choose.

Cost #1: Premium

Just like with the regular healthcare insurance you had when you were working, you are going to have to pay a premium for your Medicare Advantage Plan. Although the premium is considered the monthly cost for enrolling in Medicare, you can pay the cost for the entire year if you want. Your premium for a Medicare Advantage plan will be based on the plan you choose as well as your financial situation.

It is important to note, that if you choose to enroll in a Medicare Advantage Program, you will still need to maintain your enrollment in Medicare Part A & Part B. Medicare Part B carries its own premium as well, so if you choose to enroll in Medicare Part C, you will be paying two premiums every month.

Cost #2: Deductibles

With regular healthcare insurance, it is common to pay deductibles each time you go to the doctor or pick up a prescription until you meet your maximum personal contribution level. With Medicare Part C, though, instead of having to continually pay deductibles, there is a set annual deductible amount, that is quite low, that you have to pay. Once you reach that, you don't have to pay any additional deductibles.

Cost #3: Copayment

A copayment is different than a deductible because a copayment a set percentage you have to pay. It is your financial responsibility for the treatment. A common copayment split is 20/80 or 25/75, which means you are responsible for paying for 20 or 25% of the service, and your insurance is then required to pick up the remaining 80-75% of the cost of your care.

The copayment amount you are expected to pay may vary based on if you are using in-network or out-of-network providers. In-network providers are essentially providers who have agreed to work directly with the insurance company and use their pay scale for treatment. Out-of-network providers are those who have not chosen to work directly with that particular insurance company and dictate their own pay scale or rates.

Cost #4: Maximum Out-of-Pocket Expenses

Finally, each Medicare Part C plan should have a maximum personal amount that you will be charged each year. This maximum is not set by the individual plans that participate in Medicare; it is set by law. The amount changes each year, usually in small upward increments.

The four costs you need to consider when choosing a Medicare Part C plan are the premium, deductible, copayment, and max personal expenses. Try to find a plan that works with your current financial situation. If you need some help determining this, there are Medicare advisors that can help you with the process.