How Much Does Medicare Cost?
- How much does Medicare cost? Are there affordable options available to help seniors with out-of-pocket costs? Find out about the costs Medicare enrollees face and how to pay them.
Medicare is the federal health insurance program for older adults in the United States. In one form or another, the program offers health coverage to more than 60 million seniors.
Many Medicare beneficiaries receive premium-free Part A hospitalization benefits, though some beneficiaries may have to pay a premium for Part A. Most Medicare enrollees must pay a premium for other components of Medicare coverage, such as Medicare Part B, Part C and/or Part D, if they are enrolled in any of these programs.
Medicare Part A and Part B premiums can often be deducted directly from a beneficiary’s Social Security payments, or they can be paid directly each month.
Knowing the likely costs of Medicare can help seniors plan their coverage amounts, though it's always best to speak with a Medicare representative or a senior financial planner before making long-term decisions for coverage.
The Structure of Original Medicare
Medicare is available to beneficiaries in two basic forms: through Original Medicare (Part A and Part B), which is provided by the federal government, or through a privately sold Medicare Advantage (Medicare Part C) plan.
Each of these enrollment options comes with its own costs, which can be difficult to pick apart for beneficiaries planning their health coverage.
Part A is the inpatient hospital coverage part of Original Medicare.
These benefits are covered under Part A:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Home health care
Hospice care is unlimited, with no time restrictions for visiting nursing services or other comfort care measures. Other services have some payment and coverage limits.
Hospital stays, for example, come with a $1,408 deductible for each benefit period, as of 2020. Part A beneficiaries generally pay no coinsurance for the first 60 days of hospitalization during a benefit period, which usually corresponds to the calendar year in which the treatment is given. From days 61 to 90, enrollees must pay up to $352 a day for time in the hospital. Beyond day 91, that coinsurance cost rises to $704 a day, with each day counting toward an overflow called lifetime reserve days. Enrollees get 60 reserve days for life, after which they must pay all hospital costs.
The vast majority of Medicare beneficiaries pay no monthly premium for Part A coverage, and most seniors are automatically enrolled in the program when they reach age 65. A small number of seniors reach eligibility age without sufficient work credits to qualify for no-cost Part A premiums, which can rise as high as $458 a month for seniors without a long enough work history or spouse work credits.
Medicare Part B helps to pay for the cost of outpatient care. This is a very broad category that covers medical office visits, non-emergency ambulance transportation, durable and disposable medical supplies and certain outpatient treatments.
Unlike Part A, Part B plans do come at a premium, and so eligible seniors must opt into coverage at the time they also get Part A. The standard monthly premium for Part B is $144.60 in 2020. The annual deductible Part B enrollees pay is $198 in the same year.
After you meet your Part B deductible, you're typically required to pay a 20% coinsurance or copay for your Medicare-covered services for the rest of the year.
Part D Prescription Drug Coverage
Since 2006, Medicare-eligible seniors have had the option to enroll in Part D, Medicare’s prescription drug benefit. Unlike Part A and Part B, Medicare Part D prescription drug benefits are provided through a private insurance company that has been approved for the program.
Costs for Part D plans vary from state to state, though most leave some unpaid expenses that seniors with fixed incomes may struggle to pay.
Part D premiums are adjusted upward based on a beneficiary’s reported income from two years prior. This is called an income-related adjustment amount (IRMAA).
Beneficiaries who earn less than $87,000 a year pay only their plan premium for coverage. Enrollees who earned above $87,000 but less than $109,000 a year in 2018 pay an additional $12.20 surcharge each month along with their plan premium in 2020. These increases continue by income bracket until topping out at an additional $76.40 a month plus the plan premium in 2020 for enrollees who had incomes above $500,000 a year in 2018.
Medigap Supplemental Policies
Many Medicare beneficiaries find that the gaps in their coverage – such as Medicare deductibles, coinsurance, copays and more – can leave them having to pay significant out of pocket costs. Medicare supplemental policies can pick up some of the coinsurance and co-payment requirements for each part of Medicare.
Medicare Supplement Insurance plan (also called Medigap) costs vary by location and the extent of plan coverage. There are 10 standardized Medigap plans available in most states, and each type of plan covers a different combination of Medicare out-of-pocket costs and can be used alongside your Original Medicare coverage.
Some seniors opt to receive their Medicare benefits through private insurance companies. These plans are collectively known as Medicare Advantage, or Part C.
Medicare Advantage plans must all offer the same benefits as Original Medicare Parts A and B, and many also offer some prescription drug benefits and extra services, such as dental and vision care.
Medicare Advantage plans are issued by private companies, and so their monthly premiums vary based on where you live and the plan you have. Most plans offer beneficiaries a group rate that can be reimbursed from enrollees’ authorized Medicare benefits. These premiums can be as low as $0 a month.
Some plans carry copayment requirements that are set to the same level as Original Medicare Part B costs, though Part C plans are allowed to charge different amounts and maintain different annual deductibles. All Medicare Advantage plans include an annual out-of-pocket spending limit, which Original Medicare doesn’t include.
Beneficiaries who qualify for Medicare may be able opt into a Medicare Advantage plan at the time they become eligible for Medicare.
Beneficiaries may also be able choose to switch from Original Medicare to Medicare Advantage, switch Medicare Advantage plans or drop their Medicare Advantage plan and return to Original Medicare during the fall Medicare annual enrollment period, also called the Annual Enrollment Period (AEP). This period runs from October 15 to December 7 every year.
Part C plans cannot be combined with Medigap supplemental insurance.