Unlike traditional Plan A/B, it has no deductible. It does have maximum out of pocket each year, a few Ks if I remember it correctly. Unless you fear you would get Very Sick, with some weird cancers or whatever, your out of pocket spend is really very little because hospitalization is ZERO copay - yes 0, but with a limit of days per admission. Outpatient actually has $160 copay.
What still costs you is the annual drug benefit - that is based on Medicare Plan D benefit. I gather you know about the term "Donut Hole"? This year the threshold to fall into donut hole is $4,400. For example, the No.1 drug on Beiden's 10 drugs to negotiate price is Eliguis. This is the best drug to control blood clot danger for AF patients. The drug costs $585 to $610 30 days supply depending on where the prescription is filled. FDA actually approved a generic in 2019, but Bristol Meyer Squip filed modification and it blocked the generic, extended the patent till 2026 as the drug accounts for 1/3 of the revenue but 1/2 of the profit. It is co-developed with Pfizer.
So an AF patient would go into donut hole by August ($600 x 7 = $4200, only $200 to the donut hole threshold of $4400 in 2023). When you are in donut hole, you pay 25% of the drug cost + 100% of the dispensing/handling fee (CVS, Walgreens, WalMart, etc who fill the prescription). You will get out of donut hole once your out of pocket spend on drugs reach $7400. Then you enter the Catastrophic Stage. Your plan will then pay MOST of your drug costs.
Cancer patients of course can easily go into donut hole and then easily go out of it due to the cancer drugs are so expensive.
