What do all Medicare-covered services (Part A and Part B) count toward in a Medicare Advantage Plan (MAP)?

Medicare-covered services under Part A and Part B contribute to the out-of-pocket maximum in a Medicare Advantage Plan (MAP). This maximum is a cap on how much you will have to spend on covered services in a calendar year. Once your spending reaches this limit, the plan pays 100% of the costs for covered services for the remainder of the year.

The out-of-pocket maximum is a significant aspect of Medicare Advantage Plans because it provides beneficiaries with a safety net, ensuring that they do not face unlimited liabilities from medical expenses. All Medicare-covered services count toward this maximum, allowing beneficiaries to have a clearer understanding of their financial exposure in terms of healthcare costs.

Other options do not accurately reflect the structure of Medicare Advantage Plans. For instance, the annual deductible refers to the amount that you must pay for healthcare services before your insurance begins to pay, but not all Medicare-covered services contribute to that. The monthly premium is a recurring charge for enrollment in the plan and does not relate to the costs of specific services. Total out-of-pocket expenses encompass broader costs, which might include non-covered services or costs that do not contribute toward the out-of-pocket maximum. Thus, the focus on the out-of-pocket maximum as the cumulative limit for Medicare-covered services aligns perfectly