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Do My Medicare Advantage Premiums Count Towards my Out of Pocket Maximum?

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.

What will I pay in premiums?

If you pay a $50 premium a month, you’ll pay $600 a year in Medicare Advantage premiums.

If you pay a $104 premium a month, you’ll pay $1,248 a year in Medicare Advantage premiums.

If you have Medicare Advantage you also must pay your Medicare Part B premium. The standard Part B premium is $134 in 2018, or $1,608 a year. If you pay $134 monthly for your Medicare Part B premium and $104 a month for your Medicare Advantage premium, you’ll pay a total of $2,856 in health coverage premiums.

What is an out of pocket maximum?

An out of pocket maximum is a limit on the amount you pay for medical bills. In 2018, the Medicare Advantage out of pocket maximum is $6,700. Knowing you have a maximum can be very reassuring. If you have a $50,000 surgery for example, you generally won’t have to pay more than $6,700 if you have a Medicare Advantage plan. Some plans may have lower out of pocket maximums, for example $3,400. An out of pocket limit is annual, meaning it resets every year.

What costs count towards an out of pocket maximum?

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:

  • Premiums
  • Bills from out-of-network health care providers
  • Services not covered by the plan

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.

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