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I’ve Noticed That Medicare Advantage Plans Have a Maximum Out-Of-Pocket Limit. Is That a Deductible?

The out-of-pocket maximum for Medicare Advantage plans is not a deductible; it is the highest yearly amount you will have to pay out of pocket for covered health-care services. This spending maximum is one important difference between Medicare Advantage plans and the traditional fee-for-service Medicare program; Original Medicare doesn’t have a yearly cap on your health-care costs.

This yearly cap does not include monthly premiums, but annual deductibles, coinsurance, and copayments may all count towards this maximum limit. The out-of-pocket maximum may be different for each individual Medicare Advantage plan and can change from year to year. Once you have reached the plan’s spending limit for that year, then your Medicare Advantage plan will cover 100% of covered health-care costs for the rest of the year.

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