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What do Medicare Advantage plans cost?

Costs vary by location and plan. Each year, plans set the amounts they charge for premiums, deductibles, co-pays, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get, and the plan can change these costs each year.

With a Medicare Advantage plan, you have to pay the Part B premium. In 2019, the standard Part B premium amount was $135.50 (or higher depending on your income). Some people with Social Security benefits pay a little less ($130 on average).

Medicare Advantage plans can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.

When calculating your out-of- pocket costs with a Medicare Advantage plan, in addition to your premium, deductible, co-payments, and coinsurance, you should also consider:

The type of healthcare services you need and how often you get them.

Whether you go to a doctor or supplier who accepts assignment. “Assignment” means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Whether the plan offers extra benefits that require an extra premium.

Whether you have Medicaid or get help from your state with healthcare costs.

Because the plan costs can change every year, if you join a Medicare Advantage plan, it’s important to review annual notices you get from your plan, including:

the “Annual Notice of Change” (ANOC), which states any changes in coverage, costs, service area, and more that will be effective starting in January. Your plan will send you a printed copy by September 30.

the “Evidence of Coverage” (EOC), which gives you details about what the plan covers, how much you pay, and more. Your plan will send you a notice (or printed copy) by October 15, which will include information on how to access the EOC electronically or request a printed copy.

If you need coverage information about a particular service, drug, or supply, you can get a decision from your plan in advance and find out how much you’ll have to pay. This is called an “organization determination.” Sometimes you have to do this as prior authorization for the service, drug, or supply to be covered. You, your representative, or your doctor can request an organization determination.

You also have the option to ask for a fast decision based on your health needs. If your plan denies coverage, the plan must tell you in writing, and you have the right to an appeal. If a plan provider refers you for a service or to a provider outside the network but doesn’t get an organization determination in advance, this is called “plan-directed care.” In most cases, you won’t have to pay more than the plan’s usual cost-sharing but check with your plan for more information.