Out of Pocket Costs

• These are usually the first few items listed on the Summary of Benefits
• They include
  • Monthly Plan Premium 
    • Monthly cost of the plan to the enrollee (USUALLY 0$)
    • Varies based on level of extra help / LIS the enrollee receives
    • Medicare Part B premium ($174.70) must continue to be paid either by
      • Medicare Beneficiary 
      • State Medicaid
  • Plan Deductible 
    • Amount that must be paid before the plan begins to cover the costs
      • Medical
      • Drugs (some plans have this with the formulary lower down the SoB)
  • Maximum Out of Pocket 
    • Most the enrollee will pay for covered hospital and medical services each year
    • Does not include any premiums or drug costs