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Co-payments

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In Medicare Advantage plans, co-pays are very different from those in traditional Medicare:

 You may pay a flat dollar co-pay for each medical service rather than a percentage of the cost. For example, a plan may charge $25 to see a primary-care doctor and $35 to see a specialist instead of charging traditional Medicare’s 20 percent. However, co-pays based on percentages are becoming more common in Medicare Advantage plans.

 Co-pays vary enormously from plan to plan and, within a plan, can change from year to year, but the amount you’re charged in January for any specific service can’t be increased for the rest of the year.

 Some types of plans, especially PPOs, charge higher co-pays if you go to doctors and other providers outside of their contracted networks.

 Most plans don’t charge a fixed deductible for a hospital stay as traditional Medicare does but instead charge daily co-pays that vary greatly from plan to plan. This arrangement may or may not work out less expensively than a fixed deductible, as I discuss in Chapter 11.

 Plans that offer routine vision, hearing, and/or dental care as extra benefits either charge co-pays for these services or offer them as optional packages that you can get only by paying a separate premium.

 Medicare Advantage plans can’t charge you more than traditional Medicare for some services, such as chemotherapy treatment for cancer, dialysis for kidney failure, and medical equipment.

Medicare For Dummies

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