•A Medicare MSA is a high deductible health plan which is combined with a savings account used to pay for health care expenses not covered under the health plan
Medicare contributes to the beneficiary’s savings account
•MSA enrollees pay for health care expenses from the savings account and then out-of-pocket until the annual deductible is met, after which the plan pays 100% for covered services
The maximum deductible for MSA plans in 2023 is $15,750, although many MSAs will have a lower deductible.
•MSAs cover Part A and Part B benefits after the deductible
•MSAs do NOT cover, Part D Medicare prescription drug benefits
MSA enrollees must enroll in a stand-alone PDP if they want prescription drug benefits
•Enrollees pay their Part B premium and any premium for supplemental benefits
•Enrollees may receive covered services from any Medicare approved provider in the U.S.
•MSAs may not have a network or may have a full or partial network of providers.
•All non-network providers must accept the same amount that Original Medicare would pay them as payment in full. This is the amount the enrollee will pay the provider before the deductible is met.
•In 2022, MA MSA plans were only available in 37 states and the District of Columbia.
MSAs: Eligibility
The following individuals are not eligible to enroll in an MSA:
•An individual who receives health benefits that cover all or part of the annual deductible under the MA MSA plan. Examples include, but are not limited to, primary health care coverage other than Medicare, Medicare hospice, certain supplemental insurance policies, and retirement health benefits.
•An individual who is enrolled in a Federal Employee Health Benefits plan or is eligible for health care benefits through the Veteran’s Administration.
•Dual eligibles entitled to coverage of Medicare cost-sharing under Medicaid.
•An individual who cannot provide assurances that he or she will reside in the United States for at least 183 days during the year for which the election is effective.
•An individual who has already elected hospice.
MSA Example
Mr. Jimenez recently enrolled in an MSA from Original Medicare. He was surprised to receive a statement from the plan indicating he had financial responsibility for the screening colonoscopy services he received two weeks prior. He called the plan and said he was confused because most preventive benefits have zero cost sharing under Original Medicare. The plan explained that under an MSA, beneficiaries must pay out-of-pocket for even preventive care services if they have not yet reached the annual deductible.
What’s a Medicare MSA Plan?
Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Account Plans available outside of Medicare. You can choose your health care services and providers (MSA plans usually don’t have a network of doctors, other health care providers, or hospitals).
Medicare MSA Plans have 2 parts
Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.
High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C) . The plan will only begin to cover your costs once you meet a high yearly deductible , which varies by plan.
Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money in a special savings account for you to use to pay health care expenses. The amount of the deposit varies by plan. You can use this money to pay your Medicare-covered costs before you meet the deductible.
How do MSA Plans work?
Read about basic steps for using a Medicare MSA Plan.
What’s covered?
Medicare MSA plans cover the Medicare services that all Medicare Advantage Plans must cover. In addition, some Medicare MSA plans may cover some extra benefits like dental, vision, and hearing services. You may pay a premium for this extra coverage.
Contact plans in your area for more information on what extra benefits they cover, if any.
Medicare MSA Plans don’t cover Medicare Part D prescription drugs
If you join a Medicare MSA Plan and want Medicare drug coverage, you’ll have to join a separate Medicare drug plan. To find available plans in your area.
Medicare Medical Savings Account (MSA) Plans
What’s a Medicare MSA Plan?
Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Account Plans available outside of Medicare. You can choose your health care services and providers (MSA plans usually don’t have a network of doctors, other health care providers, or hospitals).
Medicare MSA Plans have 2 parts
Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.
Medicare Advantage Plan (Part C)
. The plan will only begin to cover your costs once you meet a high yearly
deductible
, which varies by plan.
How do MSA Plans work?
Read about basic steps for using a Medicare MSA Plan.
What’s covered?
Medicare MSA plans cover the Medicare services that all Medicare Advantage Plans must cover. In addition, some Medicare MSA plans may cover some extra benefits like dental, vision, and hearing services. You may pay a premium for this extra coverage.
Contact plans in your area for more information on what extra benefits they cover, if any.
Medicare MSA Plans don’t cover Medicare Part D prescription drugs
If you join a Medicare MSA Plan and want Medicare drug coverage, you’ll have to join a separate Medicare drug plan. To find available plans in your area.
