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Prices and coverage will differ between Medicare plans, so it’s important to take into account the out-of-pocket costs you will pay in monthly premiums as well as deductibles, coinsurance and copays.
Let’s compare price factors that apply to Medicare Part A and Part B coverage and to other Medicare plans that may be available to you.
What are premiums, deductibles and copayments/coinsurance?
Here’s a short definition of premiums, deductibles, copayments and coinsurance.
- A premium is the amount you pay monthly to have the plan.
- A deductible is an amount you pay out-of-pocket before the plan begins to pay.
- Copayment is a set dollar amount you pay at time of a service and coinsurance is a percentage you pay at time of service.
Medicare Part A and Part B price breakdown
If you are receiving your Medicare coverage from Medicare Part A and Part B, you will pay your Part B premium and Part A and Part B deductibles.
Most Medicare beneficiaries receive Part A coverage “premium free” because they (or their spouses) have paid Medicare taxes for 40 quarters or more while working.
Medicare Part B typically comes with a premium. There is a standard premium amount determined by the federal government each year. If your income is above a certain amount, you may be subject to an Income Related Monthly Adjustment Amount (IRMAA). If you don’t sign up for Medicare Part B as soon as you’re eligible for Medicare, you may have to pay a late-enrollment penalty each month that you are enrolled in Part B. You generally have to pay a Medicare Part B premium even if you have a Medicare Advantage plan.
The Part A deductible applies to each benefit period within a given year. (A benefit period begins when you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient care for 60 days in a row.) You may pay multiple deductibles within a year if you receive inpatient care several times during the year.
In contrast, the Medicare Part B deductible is an annual out-of-pocket cost that you pay before Medicare pays for diagnostic care and medical treatments. The Medicare deductible may increase slightly each year.
You will also pay Medicare’s Part A copay for inpatient care and the Medicare Part B coinsurance, which is usually 20% of the Medicare approved amount for covered services you receive from health-care providers who accept Medicare assignment. You can learn more about Medicare Part A and Part B deductibles and coinsurance by referring to your Medicare & You handbook.
Medicare Supplement plans price breakdown
Many people purchase a Medicare Supplement (Medigap) Insurance Plan to cover some of the out-of-pocket costs of Medicare Part A and Part B coverage, especially if they frequently visit the doctor or live in multiple locations during the year.
Offered by private insurance companies, Medicare Supplement plans provide standardized benefit coverage. You will generally pay a monthly premium for Medicare Supplement insurance. Premium prices can vary dramatically among insurance companies, even when they offer the same standardized Medicare Supplement benefit coverage. Premiums may increase over time. Some Medicare Supplement plan types have deductibles and/or coinsurance.
Stand-alone Medicare Part D Prescription Drug Plans price breakdown
Often people with Medicare Part A and/or Part B coverage enroll in a Medicare Part D Prescription Drug Plan to receive Medicare’s prescription drug benefits. Offered by private insurers contracted with Medicare, Medicare Part D Prescription Drug Plans typically charge a monthly premium for coverage. These Medicare plans may also have deductibles and generally have copays and coinsurance for different classes of covered prescription drugs. Premium prices, deductibles, and coinsurance/copays vary among Medicare Part D Prescription Drug Plans.
Medicare Advantage plans price breakdown
If you enroll in a Medicare Advantage plan, you will generally still pay your Medicare Part B premium. Offered by private insurance companies contracted with Medicare, Medicare Advantage plans provide at least the same coverage as Medicare Part A and Part B (except hospice care, which Part A covers) and often provide additional benefits, such as prescription drug, vision, and hearing coverage. Some Medicare Advantage plans have plan premiums as low as $0, meaning you do not pay a premium in addition to the Part B premium. .
Many Medicare Advantage plans have lower deductibles and cost-sharing amounts (coinsurance and copays) than Medicare Part A and Part B.
Medicare Coverage Options and Price Comparison At-a-Glance
|What you pay||Medicare Part A and Part B||Medicare Supplement (with Medicare Part A & Part B)||Medicare Part D Prescription Drug Plan (with Medicare Part A and/or Part B||Medicare Advantage Plan (with or without Part D Prescription Drug Coverage)|
|Premium||Yes – Part BPerhaps Part A if you or spouse did not pay 40 quarters of Medicare taxes||Yes – in addition to Medicare premium.||Yes – in addition to Medicare premium.||Some MA plans premiums “as low as $0” – in addition to Medicare Part B premium|
|Deductible||Yes – Part A and Part B||No, generally,except Plan F (High Deductible)||Yes – Generally, plan sets its deductible, if applicable. (Compare Medicare plans offering prescription drug coverage)||Some Medicare plans– Generally plan sets its own deductible, if applicable. (Compare Medicare Advantage plans)|
|Co-insurance %||Yes – Part A and Part B||Some Medicare Supplement Plans – C, D, F, G, K, L, M, and N – for select covered services||Yes – Generally, plan sets its coinsurance, if applicable, to certain types of covered prescriptions||Some Medicare plans – Generally Medicare Advantage plans limit coinsurance to select covered services|
|Copay||Yes – Part A||No||Yes||Yes|
|Is there a limit to out-of-pocket expenses?||No||No, generally, except Plans K and L||Yes||Yes|
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*Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.