Costs for Medicare health plans

What you pay in a Medicare health plan

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

  • Whether the plan charges a monthly premium .
  • Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service ( copayment or coinsurance ). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare .
  • The type of health care services you need and how often you get them.
  • Whether you go to a doctor or supplier who accepts assignment (if you're in a PPO, PFFS, or MSA plan and you go out-of-network ).
  • Whether you follow the plan's rules, like using network providers.
  • Whether you need extra benefits and if the plan charges for it.
  • The plan's yearly limit on your out-of-pocket costs for all medical services.
  • Whether you have Medicaid or get help from your state.
Note

Each year, plans establish the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.

Get more cost details from your plan

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC) and "Annual Notice of Change" (ANOC) your plan sends you each fall. The EOC gives you details about what the plan covers, how much you pay, and more. The ANOC includes any changes in coverage, costs, or service area that will be effective in January.

If you don't get these important documents, contact your plan.