For that reason, Medicare Advantage PPO plans list one out-of-pocket maximum amount for in-network services, and one out-of-pocket maximum amount that combines in-network and out-of-network healthcare costs. Both types have provider networks, but PPO plans typically pay a percentage of your healthcare costs when you see an out-of-network provider. There are several different types of Part C plans, including HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations). The Medicare out-of-pocket maximum for Part C plans is established by the insurer that manages the plan. Part C plans are sold by Medicare-approved private insurers for this purpose. Many Part C plans also offer lower out-of-pocket limits of $6,000 or less. For in-network services in 2021, the highest Medicare out-of-pocket maximum a Part C plan could allow was $7,550.
This means there is an automatic limit on the amount of money you will spend for covered healthcare during any given year. Unlike Original Medicare, Part C plans are required to have out-of-pocket maximums. Medicare Advantage plans are an alternative way to get full Medicare coverage.
Instead of Original Medicare you may have, or be interested in getting, a Medicare Advantage (Part C) plan. If you have Original Medicare, there’s no ceiling on the amount of money you may have to pay for covered inpatient or outpatient services. Original Medicare consists of two parts - Part A and Part B. Many people are surprised to learn that Original Medicare doesn’t have out-of-pocket maximums.