Medicare Advantage Plans: The “All-in-One-Plan”— But Don’t Miss These 3 Cost Gaps That Can Cost You Thousands!

Did You Know That Medicare Advantage plans have these"3" Out-of-Pocket Exposures?

Medicare Advantage Plans (Part C) are popular here in Pickens, Anderson, Greenville, and Oconee counties for a reason: it bundles “Hospital, Outpatient, Prescription drug and, extras like Dental, Vision, and Hearing in one plan—often with a $0 plan premium. That convenience is real, and in 2025 the majority of MA-PD plans charge no additional premium beyond Part B.

But “$0 premium” does not mean $0 costs when you need care.

There are “3” areas that routinely surprise folks:

1. Daily hospital inpatient copays,

2. Skilled Nursing Facility (SNF) costs after day 20 - for days 21-100

3. 20% coinsurance for Part B treatments (such as many chemotherapy drugs)

The out-of-pocket exposure you will face until you reach your plan’s annual maximum out-of-pocket (MOOP). Annual maximums range anywhere from $4000 to over $9000 in most medicare advantage plans. Let’s walk through each, then show you the simple way local families in our area help plug these holes.

Gap #1 — Daily Hospital Co-pays Can Stack Up Fast

Why This Matters in Upstate SC

Most Medicare Advantage plans use per-day hospital copays (for a set number of days) rather than a single deductible. That daily amount varies by plan, but it’s common to see significant per-day charges anywhere from $350 or more per day for the first several inpatient days. A short stay can be manageable; a longer one can snowball quickly. (Exact copays differ by plan—review your plan’s EOC or call us and we’ll answer all your questions.)

How to make sure this is covered

A Hospital Indemnity plan pays you a lump-sum per hospital day (you choose the daily amount when you enroll). That cash benefit paid directly to you can offset or fully match your MA plan’s daily hospital copays. These policies are designed specifically to cushion MA cost-sharing like copays and deductibles. Even with Pre-existing conditions, most of these plans will cover any pre-existing condition after a period of six months.

Gap #2 — Skilled Nursing Facility costs after day 20

The 21–100 day surprise

If you need rehab in a Skilled Nursing Facility after a qualifying hospital stay, Original Medicare’s 2025 benchmark is $0 for days 1–20 and $209.50 per day for days 21–100 in a benefit period. Medicare Advantage plans often mirror this structure with their own cost-sharing. Many people aren’t ready for the day-21 bill.

Put numbers on it: at $209.50/day (2025), that’s about $6,285 for a 30-day month if you remained in a facility past day 20. It adds up. (MA plan amounts can differ—always check your plan’s Evidence of Coverage.)

How to make sure this gap is covered

A Hospital Indemnity plan can include Skilled Nursing Facility / Rehab Daily Benefits specifically for days 21–100. You set a per-day amount (for example $200–$300/day) so the policy pays you directly during those higher-cost days. That payment can help you stay focused on recovery and save thousands of dollars.

Gap #3 — 20% Coinsurance for Many Part B Treatments (like chemo)

The Reality Behind “$0 Premium”

Under most Medicare Advantage plans, many Part B services—including numerous chemotherapy infusions—have up to 20% coinsurance (or an equivalent copay) until you reach the plan’s annual maximum out of pocket for Parts A/B services. Medicare Advantage Plans cannot charge more than 20% for in-network Part B chemo drugs, but 20% of a big number is still a big number, and you pay that share until you hit the annual maximum out of pocket (MOOP) you are responsible for. In 2025, CMS allows an in-network MOOP up to $9,350 and some plans will be even higher for 2026. (plans can set it lower; check yours).

How to Make Sure the Gap is Covered

Add a lump-sum cancer rider (often $5,000–$25,000) to your Hospital Indemnity plan. If you’re diagnosed, it pays you cash you can apply toward that 20% coinsurance, travel, or other expenses—helping you reach or avoid financial strain before you reach your plans annual maximum out of pocket.

What do Hospital Indemnity Plans Typically Cost (and why locals choose them)

Local Perspective

For many Upstate SC households, a Hospital Indemnity plan with optional cancer lump sum benefits often runs about $35–$50 per month depending on age, benefit amounts, and riders. That’s not nothing—but compared to a month of skilled nursing care coinsurance or several chemo infusions, it’s a small lever with a big payoff when you need it. (We’ll price it out for your exact ZIP and plan.)

Peace of Mind for Real Life

Think of Medicare advantage plans for what it is: a strong all-in-one foundation that can be made even more resilient. Pairing your MA plan with targeted hospital indemnity benefits can turn a scary unknown into a predictable line item, so a hospital stay or cancer therapy doesn’t blow up your families budget.

Action Steps for “Medicare’s Annual Enrollment Period” AEP (Pickens, Anderson, Greenville, Oconee counties)

Review, Your Plans Benefits, Then Patch the Gaps

1. Confirm your 2025 MA copays and MOOP. Look at inpatient per-day copays, SNF day-21+ charges, and Part B coinsurance for chemo/infusions. (If you need help finding these, send us your plan name.) For context: 2025 Skilled Nursing Facilities coinsurance benchmark is $209.50/day after day 20; MA plans use their own schedules, but costs are real.

2. Decide your safety net. Choose daily hospital and SNF amounts and, if appropriate, a $5k–$25k cancer rider to offset 20% Part B costs until your plan’s maximum out of pocket (MOOP)

3. Enroll during AEP. Medicare’s Annual Enrollment runs Oct 15–Dec 7 for plan changes effective Jan 1. We’ll make the process easy to understand and we are a local agency in Upstate SC trusted since 1999 (not a 1-800 call center).

Need understanding on how your plan works and how you can help minimize your out-of-pocket exposure? Call our office at (864) 868-5194 or contact our office. We’ll help point out your plans exposures into real dollars and show you hospital indemnity options to cover these gaps that can fit into anyone's budget.