The Cost Structure of Medicare Advantage Plans

Medicare Advantage (MA) plans offer great value and typically cost less than Medicare Supplement plans. MA plans, unlike most Supplement plans, come with copays—allowing you to pay only for the health care services you need. Our client advisors are here to make copays simple.

We want to offer knowledge and guidance so that you can make the best decisions for your health care needs. See below for more information about the cost structure of MA plans.

What are Copays?

copay (or copayment) is a fixed dollar amount set by the insurance company that you pay when you receive medical services. Your health insurance plan could come with different copays for doctor’s visits, emergency room visits, and so on.

MA plans have a “pay-as-you-go” system where you’ll only pay copays when you receive medical services.

What is an Out-of-Pocket Maximum?

An out-of-pocket maximum is the most an individual will have to pay for covered medical expenses in a calendar year. On an MA plan, after you pay the maximum out-of-pocket costs (through copays and/or coinsurance), your plan pays all covered medical expenses through the end of the plan year.

Why MA Could Be a Better Choice

Pay as You Go & Save Money

If you don’t like the idea of making payments each time you visit the doctor, think of it this way: Imagine paying for a monthly service such as a TV streaming service or gym membership, and then only using that service two or three times a year. Would it be worth it you?

Paying for your doctor’s visits two to three times per year will ultimately save you money—compared to paying every month when you only see the doctor a couple times a year.

This pay-as-you-go system can save you money in the long run. You can save the money you’d usually be spending for your monthly premiums in case an emergency does come up. With an MA plan, you could spend less, save more, and access more benefits.

Out-of-Pocket Maximums Cap Spending

The out-of-pocket maximum acts as a safety net. After that amount is reached, the insurance company fully pays for covered services. Out-of-pocket maximums ensure you spend only a certain amount each year, helping you budget your health care costs.

MA plans are continually improving, and many Medicare beneficiaries are now enrolled in MA plans. While MA plans already have extensive benefits, experts forecast MA plan benefits to improve in 2022 and beyond.

Have Questions? Reach Out to Our Advisors in Medicare

If you’re interested in learning more about Medicare Advantage plans, reach out to our local advisors in Medicare at 1-877-222-1942. We’d love to help!

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