In which circumstance might a beneficiary face higher out-of-pocket costs?

Beneficiaries may face higher out-of-pocket costs when they visit out-of-network providers due to the structure of most Medicare Advantage plans. These plans typically feature a network of preferred providers, and using services outside of this network usually results in higher cost-sharing. This can include higher copayments, coinsurance, or the entire cost of services not covered by the plan if out-of-network providers are utilized.

In contrast, consistently using in-network providers typically leads to lower costs as these providers have agreed to accept the plan's payment rates. Utilizing preventive services and attending wellness check-ups generally have lower or no costs associated when covered by Medicare, making these options less likely to incur higher out-of-pocket expenses.