Medicare Advantage is a Medicare-approved plan administered by private insurance companies that offer an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

In addition to including Part A and Part B benefits, many plans offer:

- Part D prescription drug coverage

-Hearing exams or hearing aids

-Routine dental care

-Eye exams, eyeglasses or contact lenses

-Wellness benefits such as gym memberships

Medicare Advantage plans are often premium free.

•You will continue to pay your Part B premium directly to Medicare, and your Part A premium too, if you have one.

•Some plans may charge premiums, deductibles, copays or coinsurance.

•Plan premiums can change each year.

•Copay amounts may vary based on the covered item or service.

•Deductibles may be applied to drug benefits and not medical benefits when a plan covers both. •Coinsurance may apply for some services.

Medicare Advantage Out-of-Pocket Maximum

Medicare Advantage plans are required to set an out-of-pocket maximum, which is the total amount you may pay for Part A and Part B services covered during the plan period — usually a calendar year. The goal of the out-of-pocket maximum is to help provide some financial protection for out-of-pocket costs. Original Medicare doesn’t offer an out-of-pocket maximum.

Plans can have different out-of-pocket maximums so long as the amount doesn’t exceed the year’s out-of-pocket maximum limit that is set by Medicare. This limit can change each year. For 2023, it is $7,400. If you reach the out-of-pocket maximum, your plan will then pay for all your covered costs for the remainder of the plan period.

It is important to understand the following costs do not count towards the out-of-pocket maximum:

•Premium payments.

•Drug costs

•Costs of extra health services a plan may offer such as vision or dental

If you join a Medicare Advantage Plan, you’ll usually get drug coverage through that plan. In certain types of plans that can’t offer drug coverage (like Medical Savings Account plans) or choose not to offer drug coverage (like certain Private Fee-for-Service plans), you can join a separate Medicare drug plan.

If you’re in a Health Maintenance Organization, HMO Point-of-Service plan, or Preferred Provider Organization, and you join a separate drug plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

You can only join a separate Medicare drug plan without losing your current health coverage when you’re in a:

-Private Fee-for-Service Plan

-Medical Savings Account Plan

-Cost Plan or

-Certain employer-sponsored Medicare health plans