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Advantage Plans

Medicare Advantage (Part C) Plans in Kentucky

Under most Part C plans, there’s a formal limit to how much you have to pay out-of-pocket each year for in-network medical services normally covered under Medicare Parts A and B. This limit is called the “maximum out-of-pocket amount for in-network medical services.” In Kentucky, during 2012, the most you have to these services is about $4,000.

An important note, related to out-of-pocket maximums: Once you’ve reached the maximum, most Kentucky Part C plans prohibit providers from mixing in additional separate charges—sometimes called “balance billing”—that they send to you directly. This prohibition applies even if the plan pays a provider less than the provider charges for a service or if there’s some other dispute between the plan and the provider.