• Eric Johnson

Costs involved with your Medicare Advantage Plan


Premiums


Most medicare advantage plans do not have a monthly premium but some do. Premiums

range anywhere from $0- $150 per month. Depending on if you get any help from the

state government your premium may be less. You are also required to continue paying

your monthly Medicare Part B premium (135.50 for 2019).


Co-pays


You will most likely pay a Co-payment when receiving services. Unlike a medicare supplement plan where you will pay a high premium and most services are covered.


For example: a nights stay in the hospital can be a anywhere from 75$ a night up to $350.

A copay for a Dr's office visit range anywhere from $0 - $25 for primary Doctor and up to $50 for a specialist visit.

Most plans cover prescription medicine as well. You will likely pay a copay for your medicine

depending on if it's a generic or brand name. The costs vary greatly from plan to plan.

This is where a broker comes into play. A broker can usually help you decide which plan will cover your medicine in the most cost effective way.


Deductibles


Some plans will charge a deductible before they offer any benefits. For example if your plan has a $250 drug deductible, you purchase a medication that retails for $500, you will pay the first $250 of that medication out of pocket, before you pay the Co-payment. The Co-payment for example might only be $45.


Some plans may include a medical deductible; before you are allowed to make Co-payments to see a Dr or visit the hospital you are responsible for X amount of Dollars.


MOOP


Maximum out of pocket responsibility: your plan will have a limit on how much you are required to pay out of your own pocket annually.


For example; a plan might say your max out of pocket is $3400 that means once you have spent $3400 in Co-pays, deductibles, coinsurance, you will no longer be required to spend anymore money to receive services.


Networks


Depending on the type of Medicare advantage plan you choose you may have higher costs to see certain Dr's if they aren't participating in your plans network.


A PPO plan has coverage in and out of network meaning if you see a Doctor who does NOT participate with the plan you will pay a copay at a higher specified amount.


An HMO plan does NOT have out of network coverage. This means if the Doctor does not participate with the plan you will be responsible for the entire bill for service.


Extra Benefits


Some plans may offer additional benefits at no extra cost such as:


Over the counter medicine(vitamins cough medicine)

Gym memberships like silver sneakers

Transportation services

PERS (personal emergency response system) like lifeline


Again it is always advisable to meet with a professional who is knowledgeable on different plans available in your area. They can help you understand what plan will work best for you.


If you would like more information feel free to message or call 941-212-9232.


-Eric Johnson

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