The average Medicare Advantage plan costs about $18 per month in 2022, including plans that charge a $0 premium, according to health policy nonprofit KFF. Total out-of-pocket costs could be much higher, depending on your health care needs.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is a bundled alternative to Original Medicare that’s offered by private insurance companies. It includes Medicare Part A and Part B, usually prescription drug coverage (Medicare Part D) and often additional benefits, which may include some coverage for dental and hearing. In 2022, 48% of people eligible for Medicare opted for Medicare Advantage plans.
What are Medicare Advantage costs?
If you have a Medicare Advantage plan, you may be responsible for paying these costs:
Medicare Advantage plans often have no premiums — 69% of Medicare Advantage beneficiaries are in plans with $0 premiums in 2022 — but it’s not an absolute. For those in plans that charge a premium, the average cost is $58 per month. Monthly premiums range from $2.10 to $302.
In addition to the Medicare Advantage plan premium, beneficiaries are responsible for their Medicare Part B premium, which is $170.10 per month in 2022. Some Medicare Advantage plans cover some or all of your Part B premium.
Prescription drug costs
For the vast majority of people with Medicare Advantage, prescription drug coverage is bundled with the plan. If you’re in a Medicare Advantage plan that charges no premium and includes prescription drug coverage, that means you pay no premium for Medicare Part D coverage. If your plan includes prescription drug coverage and charges a premium, the drug benefits are included in that cost.
Coinsurance, copayments and deductibles
Depending on your Medicare Advantage plan, you’ll typically have to pay a deductible, coinsurance and/or copayments when you seek medical care. Because many plans have no premium, it’s helpful to understand the plan’s cost structure, especially if you have a chronic condition.
Deductible: The amount you’ll pay out of pocket before your Medicare Advantage plan starts covering eligible services.
Coinsurance: A percentage of your medical costs — 20% of services, for instance — you pay out of pocket, generally after you hit your deductible.
Copayment: A flat fee you pay for a specific service, such as a doctor’s visit or emergency room trip.
These payments are out-of-pocket costs, and Medicare Advantage plans are required to have a limit on what you can pay out of pocket each plan year. That limit can’t be higher than $7,550 in 2022 for in-network services, and the average out-of-pocket limit is $4,972. For in-network and out-of-network services combined, the average out-of-pocket limit is $9,245.
Prescription drug benefits have separate out-of-pocket costs. Part D spending has no out-of-pocket limit, although once you hit $7,050 for 2022 in drug spending, you’ll pay only 5% of costs for the rest of the plan year. (Starting in 2025, out-of-pocket drug spending will be capped at $2,000 per year.)
Costs for additional benefits
Medicare Advantage plans typically offer access to extra benefits that aren’t available under Original Medicare. Some plans charge an additional fee for extra coverage.
For instance, members of some Kaiser Permanente Medicare Advantage plans have access to the company’s Advantage Plus benefits package, which costs $16 per month for comprehensive dental, hearing and additional vision care. Most Medicare Advantage plans, however, include extra benefits in the cost of the plan.
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