If you're enrolled in a Medicare Advantage Plan, you may be wondering if you have to pay a deductible like you do with Original Medicare. The answer depends on the specific plan you choose.
What is a Deductible?
A deductible is the amount you have to pay for health care services before your insurance plan begins to pay.
With Original Medicare, there is a $164.90 Part B deductible in 2023. This means you have to pay the full cost of Part B-covered medical services up to $164.90 before Medicare starts paying its share.
There is also a Part A deductible for hospital or skilled nursing facility stays. In 2023, the Medicare Part A deductible is $1,600 per benefit period.
Do Medicare Advantage Plans Have Deductibles in 2023?
Unlike Original Medicare, most Medicare Advantage Plans do not have an annual deductible for Part A and Medicare Part B services. According to Medicare.gov, many Medicare Advantage Plans have a $0 deductible.
However, some Medicare Advantage Plans may have deductibles that apply before the plan begins to pay for covered services. These deductibles can vary in amount depending on the specific plan.
For example, a Medicare Advantage HMO may charge a $500 deductible while a Medicare Advantage PPO has a $1000 deductible. The deductible amount can also vary based on whether you're using in-network or out-of-network providers.
Medicare Part D Deductible
All Medicare Advantage Plans include prescription drug coverage, also known as Medicare Part D. For Part D, there is an annual $505 deductible in 2023 before the plan starts paying for your prescriptions. However, some Medicare Advantage Plans pay this Part D deductible for you.
If your Medicare Advantage Plan does not cover the Part D deductible, you will have to pay the first $505 of your prescription drug costs out-of-pocket before the plan's coverage begins.
Medicare Advantage Out-of-Pocket Maximum
In addition to deductibles, most Medicare Plans also have an annual out-of-pocket maximum. This is the maximum amount you'll pay in copays, coinsurance, and deductibles for Medicare-covered services each year.
In 2023, the out-of-pocket limit for Medicare Advantage Plans cannot exceed $8,300. Plans may have a lower out-of-pocket cap such as $5,000 or $6,700. Once you reach the plan's out-of-pocket limit, you'll pay nothing for covered services for the remainder of the year.
Things to Know About Deductibles when evaluating Medicare Advantage Plans, here are a few key things to keep in mind about deductibles:
Use Medicare's Plan Finder tool on Medicare.gov to compare Medicare Advantage Plan options in your area. Look at the plan's Summary of Benefits to see the deductible amount for services. This will help you estimate your total annual costs in the plan.
If you have limited income and resources, look for Special Needs Plans (SNPs) that offer $0 deductibles, low copays, and extra benefits. You may also qualify for Medicare Savings Programs to help pay Medicare costs if you have limited income and assets.
Selecting the right Medicare Advantage Plan takes research, but it's worth comparing all your options. In most cases, Medicare Advantage Plans provide extensive coverage with low out-of-pocket costs - just be sure to confirm the deductible amount before enrolling.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at The Insurance Space a Call at (866) 717-8683. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
What is Medicare Part C?
Medicare Part C, also called Medicare Advantage, refers to private Medicare Plans that contract with Medicare to provide Part A and Part B benefits. Medicare Advantage Plans in 2023 include HMOs, PPOs, and more.
Do I have to pay the Medicare Part B deductible if I enroll in Medicare Advantage?
Most Medicare Advantage Plans do not have a Part B deductible, unlike Original Medicare which has a $164.90 Part B deductible in 2023. However, some Medicare Advantage Plans may charge a deductible.
How can Medicare Supplement insurance help?
Medicare Supplement insurance, or Medigap, can help pay costs not covered by Medicare Parts A and B like deductibles and coinsurance. Medigap Plans work alongside Original Medicare.
When can I enroll in Medicare if I'm turning 65?
You have a 7-month enrollment period to sign up for Medicare that spans 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65. Most people enroll in Medicare Part A and Part B at age 65.
What's covered under Medicare Part A and Part B?
Medicare Part A covers hospital, skilled nursing, and hospice care. Medicare Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment. Most Medicare Advantage Plans cover all Part A and Part B services.
Where can I learn more about Medicare coverage options?
You can visit Medicare.gov, use the Medicare Plan Finder, or contact your State Health Insurance Assistance Program (SHIP) to learn about Original Medicare, Medicare Advantage, Part D Plans, and Medigap.
Do Medicare Advantage Plans offer prescription drug coverage?
Yes, all Medicare Advantage Plans must provide the same Part D prescription drug coverage as standalone Part D Plans. This covers retail and mail-order prescriptions.
If I enroll in a Medicare Advantage Plan, do I still have to pay Part B premiums?
Yes, if you enroll in a Medicare Advantage Plan you will still pay your monthly Part B premium. In 2023, the standard Part B premium is $164.90.
Can I join any Medicare Advantage Plan or am I limited to certain ones?
When you enroll in Medicare initially, you can join any Medicare Advantage Plan offered in your area. Medicare Advantage open enrollment is from Jan 1 to March 31 each year.
How do I enroll in a Medicare Advantage Plan?
You can enroll in a Medicare Advantage Plan when first eligible for Medicare, during open enrollment from Oct 15 to Dec 7, or during the Medicare Advantage open enrollment period from Jan 1 to March 31.