Maximum Out-of-Pocket Limits for Medicare Advantage

Maximum Out-of-Pocket Limits for Medicare Advantage

Out-of-pocket costs are a big concern for Medicare-eligible individuals as they compare and choose Medicare insurance plans. Even though Medicare plans help cover many costs associated with your medically necessary services and supplies throughout the year, there are out-of-pocket expenses you will be responsible for. This can include monthly premiums, yearly deductibles, coinsurance and/or copayments. You could also face unexpected costs for medical supplies or prescription drugs to treat a new diagnosis.

With Original Medicare Part A and Part B, you will likely pay co-insurance when you receive treatments or visit a doctor. Depending on your health, these expenses can add up. There is no cap to the out-of-pocket expenses you may pay each year if you have Original Medicare.

In order to help ease the stress caused by potentially devastating medical expenses, Medicare Advantage (or Part C) Plans have an annual out-of-pocket maximum limit. In 2021, this out-of-pocket limit set by the federal government is $7,550. Medicare Advantage Plans can differ in their benefits and costs, including their out-of-pocket limits, but they can’t have a higher out-of-pocket limit than the federal government allows.

When comparing and ultimately choosing a Medicare Advantage Plan, you should note that out-of-pocket limits will vary. Medicare Advantage Plans can vary in overall benefits and costs, so it is important to review your own personal coverage needs and financial goals before choosing a plan. Find the Medicare insurance plan that will fit your lifestyle and preferences. For instance, some plans may offer a higher premium with a lower out-of-pocket limit. Only you can decide which plan will meet for your own needs, but if you need assistance, talk to a licensed agent who can help answer any questions you may have.

Yearly costs may change from year to year, so if you are enrolled in a Medicare Advantage Plan that did not quite meet your needs during this past year due to changes in your health, budget, or lifestyle, you should take the time to review your Summary of Benefits and compare all of your options prior to Medicare’s Annual Election Period, which starts October 15 and ends December 7.