With a Medicare Advantage plan after I reach the max out of pocket, $3,000 or more, will I have any copays or fees the rest of the year?
Answered by 8 licensed agents
The Medicare Advantage plans cover the Part A and Part B of Medicare expenses. So, although you mostly won't have any concerns about paying more out of pocket above that, you will still have to pay for your Part D prescriptions, any dental or vision, gym costs, etc. If you have any needs that take you Out of Network, you will be responsible for those costs as well.
This is a good question. Most younger beneficiaries would not be concerned. As we all age, the risk of excessive costs and payments grows. What is my risk of some continued OOP fees.
Once you reach your maximum out-of-pocket (MOOP) limit on a Medicare Advantage plan, you will not pay any more copays, coinsurance, or other out-of-pocket costs for Medicare-covered services for the rest of the calendar year. That means:
No more copays for doctor visits, hospital stays, or outpatient services
No coinsurance for procedures, labs, or diagnostic tests
Your plan covers 100% of covered medical services after you hit the MOOP
You will not have anymore copays or fees for medical reasons, but you still will have prescription costs. Your medical out of pocket cost is separate from your prescription out of pocket cost.
Max out of pocket means exactly what it says. It's the total you paid for all health services in either co-pays or co-insurance, on your plan, year to date. Rx costs are excluded from that because the Rx MOOP is $2,000. So if you reach your MOOP of health costs, then yes, you will not have any further co-pays or co-insurance, again, excluding Rx's.
