Medicare Medical Savings Account (MSA) plans must provide you with the same benefits as Original Medicare but may do so with different rules, restrictions, and costs. MSA plans can also offer additional benefits. Below is a list of general cost and coverage rules for MSA plans. Remember to speak to a plan representative to learn the details about any plan you are considering.

Also note that if you were enrolled in a Medigap policy before joining an MSA plan, you may keep your Medigap. However, your Medigap will not provide any coverage while you are enrolled in an MSA plan, and you must continue paying your Medigap premium.

Costs

  • MSA plans typically do not charge a monthly premium in addition to the Part B premium, but some may.
  • MSA plans work with a high deductible health plan (HDHP) and a bank account. Your plan deposits funds for your medical expenses into the bank account, and you can then use these funds to pay for care.
    • You will likely have high out-of-pocket costs for your care until you reach your deductible. After reaching your deductible, your MSA plan covers 100% of the cost for Medicare-covered services.
    • Funds contributed to an MSA are not taxed as long as they are used to pay for qualified medical expenses.
    • You can use MSA funds for other expenses, but those funds will be taxed and will not count toward your HDHP deductible.
    • Any remaining money in your bank account at the end of the year remains in your account for the next year, in addition to your plan’s regular yearly contribution.
    • If you join an MSA plan after January 1, your yearly deductible will be pro-rated to the number of months left in the year. For example, if your plan’s yearly deductible is $6,000 and your coverage starts September 1, your deductible for that year will be $2,000 (one-quarter of the yearly deductible).
    • You keep any money left in the account if you leave your MSA plan at the end of the year. You will not be taxed if you use the money left in the account for qualified medical expenses.
    • If you leave the plan midyear, part of the money will be refunded to Medicare depending on the number of months left in the year.

Providers

  • MSA plans cover in-network care (if the plan has a network), as well as out-of-network care. However, you may pay a higher amount for out-of-network services.
    • You pay the least when seeing in-network providers.
    • If your plan does not have a provider network, you pay the least when seeing participating providers (providers who take assignment). These providers will only charge the Medicare-approved amount.
    • If you see non-participating providers, you may pay up to 15% more than the Medicare-approved amount. The additional 15%, in addition to the Medicare-approved amount, counts toward meeting your deductible.

Benefits

  • MSA plans to not provide Part D coverage, and you must join a stand-alone Part D plan for such coverage. Out-of-pocket expenses for your prescription drugs do not count toward your MSA plan’s deductible.
  • Your MSA plan may offer additional benefits, such as vision, hearing, and/or dental care. Check with the plan directly to learn about coverage rules and restrictions for any added benefits.
    • You may be charged an additional premium if you choose to receive these benefits.
    • Your out-of-pocket costs for these services count as qualified medical expenses, but they do not count toward your deductible.

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