Many Medicare Advantage plans require that you pay a copay when you see a doctor. This is a fixed cost and an alternative to Original Medicare's 20 percent coinsurance.
Medicare Advantage plans offer the ability to receive the same benefits as Original Medicare, but from a private insurer.
However even with the added flexibility that Medicare Advantage plans provide, you may still be responsible for out-of-pocket costs, including copays.
A Medicare copay is the amount of money you're required to pay for a covered Medicare service or good. A copayment is typically a flat fee.
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Why Medicare Advantage?
More than 28 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This equals nearly half the total population of Medicare-eligible Americans.1
Many are likely drawn to the unique benefits of Medicare Advantage plans as compared with Original Medicare:
Medicare Advantage plans may often include additional benefits for prescription drugs, dental care, and vision care.
The average premium for a Medicare Advantage plan that includes prescription drug coverage is $17.60 per month in 2023.2 Some plans may not have a monthly premium, and some may even help pay you back for your Medicare Part B premium.
Medicare Advantage, unlike Original Medicare, comes with an out-of-pocket limit, which means your out-of-pocket spending will be capped.
While plans are offered by private insurers, you are still guaranteed the benefits of Original Medicare.
Medicare Advantage costs
Medicare Advantage out-of-pocket costs can include:
Medicare Part B premium Even under Medicare Advantage, you must still pay your Part B premium (unless your plan helps pay for it). The standard Part B premium in 2023 is $164.90 per month.
Deductibles Some plans require you to meet a deductible when seeing doctors, visiting hospitals, or getting your drugs filled.
Medicare copay Many Medicare Advantage plans require that you pay a copay when you see a doctor. This is a fixed cost — and an alternative to Original Medicare’s 20 percent coinsurance.
Premiums As noted above, the average monthly premium for Medicare Advantage plans with drug coverage is $17.60 per month in 2023.
Note: these costs may be higher (or lower), depending on your plan.
Compare Medicare plan costs
As you compare your options, you should weigh the costs of Medicare Advantage against the additional benefits you may receive, as compared to staying with Original Medicare.
Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
1 Freed M, et al. (Nov. 10, 2022). Medicare Advantage 2023 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/medicare-advantage-2023-spotlight-first-look.
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