Medicare Advantage plans offer tremendous value because of their low or $0 premiums. They also provide broader coverage by including many benefits that Original Medicare does not.
But those low premiums don’t tell the whole story. Medicare Advantage plans should be evaluated considering the out-of-pocket costs you might be exposed to as you use different plans.
Those costs include three areas:
Deductibles, or what you have to spend before your plan starts paying.
Copays, or the fixed fee you pay for each doctor visit, prescription drug or other service.
Coinsurance, or the percentage you pay of the costs after you have reached your deductible.
With those possibilities, here are five ways you can save on upcoming medical expenses if you have a Medicare Advantage plan.
Demand price transparency
Hospitals can charge different fees for the same service, partly because they negotiate different deals with each insurance company. And typically, you wouldn’t know the hospital fees of a procedure or service until you saw the invoice. But in early 2021, the Transparency in Coverage[1] rule went into effect, requiring hospitals to provide real-time access to cost information (including your liability under your plan). This is useful for services you can schedule in advance, such as outpatient visits, physical therapy, joint replacements, imaging and lab tests. If your plan gives you the option of different hospitals and facilities, you will be able to make cost-conscious decisions with greater information.[2]
Takeaway action step: Visit your hospital’s website before scheduling any procedures or services. Do the same for other hospitals in your network. You may need to get the specific medical code for the procedure or service from your doctor. Then, compare the costs by entering the code and your Medicare Advantage plan information on each website.
Shop the plans
As you approach Medicare age – at 65 – you may already have a chronic condition and take certain medicines. So, review your current health care use. Then, as you select your first Medicare Advantage plan (and later as you renew or replace your plan at each year’s enrollment), check the costs of regularly used services.
Takeaway action step: Do you visit lots of doctors? Look at the copays or coinsurance for each visit. Check the deductible. If your medical usage is high, find a low deductible, so your plan kicks in early. If usage is very low, find a high deductible if it lowers your premiums. And find the plan that covers your existing medicines at the lowest possible price.
Use the calendar
Do you have a non-emergency procedure coming up? Schedule it for after you have met your annual deductible. That way, you won’t be paying for your deductible and the procedure’s copayments together. The same holds for prescription drugs. If you’ve met your annual deductible, be sure to refill as many prescriptions as you can before the new yearly deductible begins on January 1st.
Takeaway action step: As you approach the last three months of the year, look at any health care services, procedures or medication purchases you might need and schedule them for before the end of the year.
Choose your lab
If your plan charges a coinsurance percentage for lab work, such as bloodwork, think about where you want it done. You could save yourself money on your share of the cost by checking on prices first.
Takeaway action step: Get the exact list of tests to be done. Check on the cost if performed in a hospital lab versus your doctor’s office versus a local outpatient lab. The price difference could be considerable.
Opt for outpatient, if possible
If you are facing ambulatory patient surgery – also called outpatient surgery – find out if it needs to be done in a hospital setting or if it can be done just as well in an outpatient setting without increased risk. For example, diagnostic tests, treatments or rehab visits could be far less expensive as ambulatory patient services.
Takeaway action step: Get the exact name or medical code for what needs to be done.Check on the cost at the hospitals in your network compared with your outpatient options.
[1] Federal Register. “Transparency in Coverage.” federalregister.gov (accessed March 29, 2022). [2] Centers for Medicare & Medicaid Services. “How To Get the Most Out Of Hospital Price Transparency.” cms.gov (accessed March 29, 2022).