Medicare Advantage Plans Have Two Caps

Last month, I was talking with a friend about his Medicare Advantage plan for 2025. He will begin taking a Tier 5 medication in January and wanted to know about the coverage and costs. I found that the drug would be covered and his costs would be capped at $2,000. He would probably meet that cap in January or February and not pay another cent for medications in 2025.

Then, we switched gears to check out the medical coverage in his plan. His physicians are in-network and his out-of-pocket costs would be capped at $4,900 in-network.