![]() In 2022, the out-of-pocket limit may not exceed $7,550 for in-network services and $11,300 for in-network and out-of-network services combined. Since 2011, federal regulation has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B. The average out-of-pocket limit for Medicare Advantage enrollees is $4,972 for in-network services and $9,245 for both in-network and out-of-network services (PPOs)įigure 3: Average Medicare Advantage Plan Out-of-Pocket Limits, Weighted by Plan Enrollment, 2022 Together, these trends contribute to greater availability of zero-premium plans, which brings down average premiums. Further, rebates paid to plans have increased over time, and plans are allocating some of those rebate dollars to lower the part D portion of the MA-PD premium. More plans are bidding below the benchmark partly because Medicare Advantage benchmarks relative to traditional Medicare have increased over time, and when benchmarks increase, plans are able to keep more for Part A and B services as well as for extra benefits. Since 2015, a rising share of plans are bidding below the benchmark, which enables them to offer coverage without charging an additional premium. ![]() The reduction is driven in part by the decline in premiums for local PPOs and HMOs, that account for a rising share of enrollment over this time period. ![]() Regional PPOs were established to provide rural beneficiaries with greater access to Medicare Advantage plans.Īverage MA-PD premiums have declined from $36 per month in 2015 to $18 per month in 2022. Nearly 6 in 10 Medicare Advantage enrollees are in HMOs (59%), 38% are in local PPOs, and 3% are in regional PPOs in 2022. However, average MA-PD premiums vary by plan type, ranging from $16 per month for HMOs to $20 per month for local PPOs and $49 per month for regional PPOs. In 2022, the average enrollment weighted MA-PD premium, including among those who do not pay a premium, is $18 per month. Premiums paid by Medicare Advantage enrollees have declined since 2015 Higher average PDP premiums compared to the MA-PD drug portion of premiums is due in part to the ability of MA-PD sponsors to use rebate dollars from Medicare payments for benefits covered under Parts A and B to lower their Part D premiums, which according to the Medicare Payment Advisory Commission (MedPAC), are $300 per enrollee annually in 2022.įor the remaining 31% of beneficiaries who are in plans with a MA-PD premium (5.7 million), the average premium is $58 per month, and averages $35 for the Part D portion of covered benefits – slightly lower than the $40 monthly PDP premium. In 2022, 87% of Medicare Advantage enrollees in plans open for general enrollment are in plans that offer prescription drug coverage.Īltogether, including those who do not pay a premium, the average enrollment-weighted premium in 2022 is $18 per month, and averages $11 per month for just the Part D portion of covered benefits, substantially lower than the average premium of $40 for stand-alone prescription drug plan (PDP) premiums in 2022. The MA-PD premium includes both the cost of Medicare-covered Part A and Part B benefits and Part D prescription drug coverage. In 2022, nearly 7 in 10 beneficiaries (69%) are in zero-premium individual Medicare Advantage plans with prescription drug coverage (MA-PDs), and pay no premium other than the Medicare Part B premium ($170.10 in 2022). Nearly 7 in 10 Medicare Advantage enrollees (69%) are in plans with no supplemental premium (other than the Part B premium) in 2022 A companion analysis examine trends in Medicare Advantage enrollment. This brief provides information about Medicare Advantage plans in 2022, including premiums, cost sharing, out-of-pocket limits, supplemental benefits, prior authorization, and star ratings, as well as trends over time. They are also permitted to limit provider networks, and may require prior authorization for certain services, subject to federal standards. For example, Medicare Advantage plans are required to provide an out-of-pocket limit, and may provide additional benefits or reduced cost sharing compared to traditional Medicare. ![]() The federal government contracts with private insurers to provide Medicare benefits to enrollees, and plans are required to meet federal standards. Medicare beneficiaries have the option of receiving their Part A and Part B Medicare benefits through a private Medicare Advantage plan. NOTE: A clarification on methods has been added to the analysis of cost sharing, by length of inpatient hospital stay.
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