Average payments to Medicare Advantage plans are 7% less than original Medicare spending.

WASHINGTON, D.C. – (September 21, 2022) – Every American deserves access to affordable, high-quality health coverage – including the more than 29 million seniors and people with disabilities who choose Medicare Advantage (MA). Today, a new study offers more compelling data and evidence that MA delivers better value for patients, consumers, and taxpayers. The study, conducted by Wakely Consulting Group on behalf of AHIP, analyzed data on original Medicare costs used to compare MA and original Medicare spending. It finds that accounting for comparable MA coverage and enrollee populations, average original Medicare costs were 9.4% higher than government estimates in 2019. source

If you are on Original Medicare, you should consider a Medicare Advantage plan today.

Medicare may pay for a portion of health care costs, but it doesn’t cover everything. How much you can expect to spend on care and services depends on several factors. Medicare has different parts. You can combine them to deliver more complete health care coverage. Depending on your choice, you may need to pay premiums, copays, coinsurance, deductibles or other costs.

Medicare Parts A and B provide coverage for essential medical care. Together, Parts A and B are called Original Medicare.

Part A covers inpatient hospital stays and some care outside of the hospital. (For instance, skilled nursing care after you leave the hospital.)

With Part A, you generally won’t have to pay a monthly premium. But you will need to pay a deductible before Medicare begins to cover any of your hospital costs. In 2022, the Part A deductible is $1,556. If you spend more than 60 days in the hospital, you will have coinsurance to pay.

What about Medicare Advantage?

Also known as Medicare Advantage, Medicare Part C plans provide at least the same coverage as Original Medicare. But if often come with more benefits. These may include coverage for:

• Prescription drugs
• Dental, vision and hearing services
• Gym memberships
• An allowance for over-the-counter (OTC) items

Before you can sign up for Medicare Advantage, you must enroll in Original Medicare. This means you’ll pay your Part B premium plus your Medicare Advantage plan premium. These plans also have a copay for each service. The amount varies by plan.

When choosing a Medicare Advantage plan, you have plenty of options. Premiums, deductibles, copayments can vary. So will your out-of-pocket costs. But these costs are often highly competitive and may be less than what you’d pay for Original Medicare.

Another thing to consider: Medicare Advantage plans limit how much you’ll spend on out of your own pocket each year. Original Medicare has no such limit. This maximum out-of-pocket (MOOP) limit means you will never pay more than a certain amount every year for your health care, if you use services and providers in your plan. In 2022, the maximum Medicare Advantage out-of-pocket limit is $7,550 for in-network services and $11,300 for in-network and out-of-network services combined. But Medicare Advantage plan members often pay less than that, depending on the plan.

Your MOOP includes deductibles, copayments and coinsurance costs. But it does not include premiums and Part D cost sharing.

Medicare Advantage plans, for example, require a copay for every doctor visit or medical service. Original Medicare charges a 20 percent coinsurance for most doctor visits and services. That means the plan only covers 80 percent of approved expenses. You must pay the other 20 percent.