MHI – Q: Are there out-of-pocket limits on Medicare Advantage and Medicare Supplement plans?

Posted by MedEd at MHI
A: Medicare Advantage plans have a maximum out-of-pocket (MOOP) of $6,700 in 2017. This amount represents the most you would have to pay in copays and/or coinsurance for Medicare-covered health services in a calendar year. In the event you reach that amount, the plan will cover your copays and/or coinsurance for the rest of the year.  There are a few things you’ll want to keep in mind about MOOP:
  • Amounts vary from one plan to another
  • A higher MOOP means you’ll pay more before the plan takes over
  • It may apply to in-network services only or a combination of in and out-of-network services (check your plan)
  • It does not apply to prescriptions
  • You must still pay your Part B monthly premium and plan premium
Medicare Supplement plans do not have maximum out-of-pocket limits. I’ll occasionally hear someone say Medicare Advantage plans are superior to Medicare Supplements for this reason. You’re going to have a hard time convincing me of that.
Let’s look at the F plan; the plan that covers all Part A and B deductibles and coinsurance. The maximum out-of-pocket you’ll pay in one year is twelve monthly premiums. Take the F plan monthly premium (at any age) and multiply it by twelve. Go ahead; use the Farm Bureau Health Plans (FBHP) monthly premium for a 91-year old. Or, better yet, the FBHP disability rate. Let me know if you come anywhere close to $6,700.
Bottom line: Medicare Advantage plans have annual out-of-pocket maximums; Medicare Supplements do not. What’s the big deal if you have no copays or coinsurance with a supplement? 

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