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A Medicare Advantage plan is a way to get your Medicare coverage from a private insurance company. A premium is an amount you pay monthly to have coverage from your Medicare Advantage plan. You must pay this premium whether or not you use covered services. What you pay in premiums doesn’t count towards your out-of-pocket maximum. Learn more about premiums and out-of-pocket maximum for your Medicare Advantage plans below.
Medicare Advantage plan premiums vary widely among plans. For example:
If you pay a $50 premium per month, you’ll pay $600 a year in Medicare Advantage premiums.
If you pay a $104 premium per month, you’ll pay $1,248 a year in Medicare Advantage premiums.
Some plans have premiums as low as $0, but plans may have other costs – deductibles, copayments, and/or coinsurance, for example.
If you have Medicare Advantage you also must pay your Medicare Part B premium. The standard Part B premium is $135.50 in 2019, or $1,626 a year. If you pay $135.50 monthly for your Medicare Part B premium and $104 a month for your Medicare Advantage premium, you’ll pay a total of $2,874 in health coverage premiums. This is just an example – again, Medicare Advantage plans premiums vary among plans.
An out-of-pocket maximum is a limit on the amount you pay for medical bills. This amount may vary year to year, and among plans. Knowing you have a maximum can be very reassuring. If you have a $50,000 surgery, for example, your out-of-pocket costs could be less than that if you have a Medicare Advantage plan.
Usually amounts you spend on coinsurance or copayments for covered services count towards your out-of-pocket maximum. For example, if you visit a primary care doctor and pay $10 and visit the emergency room and pay $100, these amounts will generally count towards your out-of-pocket maximum.
Costs that typically do NOT count towards your out-of-pocket maximum include:
Would you like to search for a Medicare Advantage plan with a low out-of-pocket maximum? Just enter your ZIP code on this page to start browsing for Medicare Advantage plans.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.