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You can import third party opt outs by importing as Email Address | Unsubscribe = TRUE or 1.
But if you do that, it will count against you for your record count.
As Greg mentioned in a long post elsewhere, you can then run a flow action Unsubscribe=T or just remove the lead from Marketo. The lead is sent to a secret table called Master Unsubscribed which will prevent you from inadvertently emailing the person again.
You can use a smart list of Unsubscribed=T to download whatever list you need.
Yes, opt outs are counted against your tier as they will be tracked on the website regardless of email.
You can upload opt-outs from third parties and add them to your opt out list and manage the whole thing from there
Lastly, you can export the optout file and email it.