The costs that you and the health insurance plan pay are split on a percentage basis. For example, you might pay 20% of the total allowed cost of a service and the remaining 80% would be paid by the plan.


The fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.


A set amount you pay out of pocket for covered services each year before your plan begins to pay.

Out-of-Pocket Maximum

The maximum amount you pay during a policy period (usually a year). This amount does not include your premium or the cost of any services that are not covered by your plan. After you reach your out-of-pocket maximum, your plan pays 100% of the allowed amount of covered services for the rest of the policy period.


The fixed amount you pay your health insurance or plan for Medicare coverage. You may pay your premium to Medicare, to a private insurance company or both, depending on your coverage. Most premiums are charged monthly.

Your Share of Medicare Advantage Costs

With Medicare Advantage plans, the company that offers the plan sets the monthly premium and decides on the cost-sharing amounts. Look at the details of each plan you’re considering to see what your share of the cost (cost-sharing) could be.

Your Out-of-Pocket Maximum

Limits on your cost-sharing is one way that Medicare Advantage plans differ from Original Medicare (Part A and Part B). Many Medicare Advantage plans offer a feature that caps your out of-pocket spending (out-of-pocket maximum) for cost-sharing expenses like copays and deductibles in any given year. This provides financial protection in case of catastrophe or medical emergency.

Prescription Drug Coverage Deductibles

Some Medicare Advantage plans have a deductible for prescription drug coverage, while others don’t. Look at the specific plan for details.


Your costs will vary from plan to plan. Shop for a plan that will fit your budget and needs.

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