Laying a Solid Foundation | Lesson 4

Medicare Advantage Costs

One of the most important factors in making a health care choice is understanding the costs in the plan. Medicare Advantage plans are no different. In this lesson we’ll be covering the costs that your clients can expect in a Medicare Advantage plan. Let’s start with monthly costs.

Medicare Advantage plans have a monthly premium, but many of them offer low or zero-dollar premium options.

In addition to their Medicare Advantage premium, your clients must pay their part B monthly premium.

Some Medicare Advantage plans even offer a Medicare Part B giveback or Premium reduction to help your clients save on their Part B premium. Next, let’s cover deductibles.

Medicare Advantage plans also have deductibles for health coverage and drug coverage if prescription drugs are covered in the plan. Like other deductibles, this is the amount the client must pay out-of-pocket before their plan’s coverage takes effect. Just like the premium, some Medicare Advantage plans offer zero-dollar health and drug deductibles.

In addition to deductibles, there are also out-of-pocket costs, like copayments and coinsurances, for the services your client receives. For example, your client may pay a five dollar copay when seeing a primary care physician or pay a twenty-five dollar copay for seeing a specialist. Some of the out-of-pocket costs your clients may be concerned about are costs for doctors’ visits, hospital stays, and prescriptions drug costs in their plan.

Medicare Advantage plans offer a little bit of financial protection by setting a maximum out-of-pocket limit.

If a client spends up to this limit, their plan covers cost sharing for Medicare-covered services for the rest of the year.

Out-of-pocket costs like deductibles, copays, and coinsurance for Medicare covered services count towards your client’s maximum out-of-pocket limit.

One of the best resources for reviewing costs in a Medicare Advantage plan is the Summary of Benefits. This document walks through the costs we’ve talked about in this lesson, and also includes information on other covered items like dental, mental health, and prescription drug coverage.

Ritter’s Medicare Quote Engine is a great way to review and compare Medicare Advantage plans in a given county. It outlines some of the basic information and enables you to easily compare plan benefits side by side.

Before we wrap up, it’s important to note that costs will vary from one MA plan to another and may have some variations based on the plan types that we’ve discussed here.

For example, PPO plans may have two different maximum out-of-pocket limits, one for in-network services and one for out-of-network services. Also, the cost structure in the MSA plan looks very different from the cost structure in a traditional HMO plan.

With all these variations it’s important to understand what costs your clients are most concerned about and factor in their budget and health needs to your recommendations.

Once you make those recommendations, your client will choose their plan. How do you your clients enroll?

We’ll cover the different Medicare Advantage enrollment periods in our next lesson.

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