With a Medicare Advantage plan you will be responsible for co-payments and other out-of-pocket expenses when you use your coverage. Each company sets its own cost-sharing for each covered service. As an example, you might pay a copay for a primary care doctor visit, a higher copay for a specialist, and a percentage of the cost of services such as x-rays or lab tests. When you use Medicare Advantage coverage in the hospital you may pay either a fixed amount per day or a flat amount for the whole stay.
All Medicare Advantage plans must also include an annual maximum cap on your out-of-pocket medical costs. Think of this maximum out of pocket limit as a safety net. If your out of pocket medical expenses add up to a certain amount in one year, your plan will step in and pay the rest of the cost for the remainder of the calendar year. It is important to note that Part D prescription drug costs care calculated separately and are not included in this maximum out of pocket number.
Medicare Advantage Plans may also include extra benefits not provided by Original Medicare such as vision benefits, limited dental coverage, or gym memberships. It is important to remember the insurance company has the right to change these benefits each year. Medicare Advantage plans also typically include Part D drug coverage.