HERE’S AN EXAMPLE

For example: let’s say that William needs a surgery that costs $6,000 in Oc-tober. His plan’s out-of-pocket maximum is $1,500, and he’s already spent $500 on routine medical care from January – October. Even if William’s co-insurance rate for surgeries is 20% (meaning he’d normally have to pay $1,200 for the $6,000 surgery), he would only have to pay $1,000 in this case, since his out-of-pocket maximum kicks in at $1,500 (and that $500 he spent earlier in the year counts toward this number).

Out-of-pocket maximum

October

William has a $10,000 surgery scheduled in October. - $10,000

His medical out-of-pocket maximum is $4,000. Since the beginning of his plan

year, he's spent $3,000 on medical care. That leaves him with $1,000 left to spend

until he reaches his spending limit.

That means William will only pay $1,000 for his surgery and

his plan will cover the rest.

Think of your medical out-of-pocket max as a big bucket

Every time you spend your own money on covered medical services or care, it goes into the bucket.

HEALTH PLAN

Now your health plan covers the cost of any Medicare-covered doctor visit or medical serviceyou need in full.

Once the bucket is full, you’ve hit your out-of-pocket maximum.

$4,000total:

$3,000

$4,000total:

has to pay$1,000

What is your Medicare Advantage plan’s

and how does it work?

Out-of-pocket max

Your money

Almost all your doctor visits and hospital stays, but not prescriptiondrug costs or monthly premiums.

What services does it include?

$

$

$