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My nephrologist wants me to take Jardiance for CKD?
Kidney Conditions | Last Active: 1 hour ago | Replies (50)Comment receiving replies
No, the out-of-pocket maximum for Medicare Advantage plans can vary, but in 2025, the federal cap for in-network maximum out-of-pocket limits is $9,350, while the combined in- and out-of-network cap is $14,000. The $2,000 limit applies specifically to out-of-pocket spending for prescription drugs under Medicare Part D.
mutualofomaha.com panfoundation.org
Medicare Advantage Out-of-Pocket Limits
Annual Out-of-Pocket Maximum
In 2025, Medicare Advantage plans have a maximum out-of-pocket limit, but it is not capped at $2,000. Instead, the federal cap for in-network services is set at $9,350. For combined in- and out-of-network services, the cap can reach $14,000.
Medicare Part D Cap
The $2,000 limit applies specifically to out-of-pocket costs for prescription drugs under Medicare Part D. This cap includes all costs related to covered medications, such as deductibles, copayments, and coinsurance.
Summary of Limits
Plan Type Out-of-Pocket Limit (2025)
Medicare Advantage Up to $9,350 (in-network)
Combined (in- and out-of-network) Up to $14,000
Medicare Part D $2,000 for prescription drugs
WOW! Wow! I think I have reached the bottom of that barrel too. I am in TN. My nephrologist is formerly a Mayo doc but said he had to get his family out of the MN winters. I'm lucky to have him.
I do have an MD, but had to see his NP as getting an appt with him would have put me in January. I have reported her twice to him and the office manager.
My Uric Acid was 8.8 at last lab test. I asked my nephologists office what I should do about it and was told they don't handle that???? Then I got a call back that my doc wanted an appt to go over the labs. I swear incompetency is running rampant.
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@tntwo99
I was confused. I thought we were only looking at the cost of medications, not of all contact with the medical world. Yes, I only pay a maximum of $2K for meds per year. I do have to pay $35 for an appt with a specialist but no co-pay to see my PCP.
I see two specialists four times a year, three more once a year (most years) and the occasional specialist a couple times a year which would be under $500 a year.
I had had bilateral total hip replacement last year with complications that turned my outpatient surgeries (!) into inpatient. (I passed out the first time the nurse got me out of bed. You should have seen the crowd in my room when I came to about two minutes later. I had triggered the emergency response team.) My total cost for the two surgeries was about $1000. I can't easily find the bills, just the payments, but suspect it was a bargain. My husband's triple bypass heart surgery three years ago (for a congenital defect) with a four day hospitalization was about the same. We were shocked, pleasantly surprised, (and had been prepared to pay much more.) I think it cost me more to put our son up in a nearby hotel (because I had covid for 22 days around this time) and taxi transportation from the airport (45 min away) because no family member was isolating from covid. There is no public transportation to our small town/now suburb which is 7 min from where my husband worked.
We have BCBS of MN Medicare Advantage Choice Plans, mid-range plans. We have also benefitted from the large in-network list which includes Mayo in Rochester as well as access to clinics in Duluth and Hudson, WI (the closest clinic to our home.) My husband chose an in network eye surgeon outside the HMO we usually use who is part of a small eye doctor only group. His cataract surgery was at least 5 years after mine and was only minimally more expensive but surprisingly inexpensive.