The Affordable Care Act (ACA or “Obamacare”) provides innovation in health care in America. Like other health insurance programs, Medicare has been affected by the ACA, resulting in some positive changes with regard to Medicare premiums, deductibles, and other costs related to health care. As a Medicare beneficiary it’s important for you to know how much Medicare costs in 2019.
Medicare premiums for 2019
Medicare premiums vary depending on the Medicare program in which you’re currently enrolled. Here’s a look at the 2019 Medicare premiums for Original Medicare, Part A and Part B, Medicare Advantage (Medicare Part C), and Medicare Part D (prescription drug coverage):
- Medicare Part A (hospital insurance): $0 premium for most people. You will, however, need to pay up to $437 per month if you have not paid Social Security taxes for at least 40 quarters (10 years).
- Medicare Part B (medical insurance): The standard Part B premium amount in 2019 is $135.50 (or higher depending on your income). Social Security will tell you the exact amount you will pay for Part B in 2019. Read here for more information about the Medicare Part B premium.
- Medicare Advantage: Medicare Advantage plan premiums vary depending on which plan you choose. The Centers for Medicare & Medicaid Services reports that Medicare Advantage premiums have fallen by nearly 10% since the Affordable Care Act was passed in 2010 and that more than 95% of Medicare beneficiaries now have access to plans with $0 premiums. 1 Note that Medicare Advantage is offered by Medicare-approved private insurance companies, and it is required by law to offer at least the same coverage as Original Medicare Part A and Part B (except hospice care, which is covered by Part A). Many Medicare Advantage plans offer extra benefits, such as routine vision, hearing, and dental care.
- Medicare Part D (prescription drug coverage): Like Medicare Advantage, stand-alone Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare. Therefore, premiums vary according to the stand-alone Medicare Part D Prescription Drug Plan in which you enroll. It’s important for you to note that you may be subject to a penalty in the form of higher monthly premiums if you remain without creditable drug coverage for 63 days or more after your initial enrollment period is over. You can calculate this late-enrollment penalty by multiplying the number of months you went without creditable coverage by 1% of the national base beneficiary premium, which is $33.19 in 2019. Then round the total to the nearest $0.10, and add it to your Medicare Part D monthly premium.
Medicare deductibles for 2019
Much like Medicare monthly premiums, Medicare annual deductibles vary depending on the plan you choose and the kind of coverage you select. Here’s a look at deductibles and Medicare-related out-of-pocket expenses for 2019:
- Medicare Part A (hospital insurance): $1,364 deductible for each benefit period. You also have to pay coinsurance if you stay in the hospital more than 60 days: $341 coinsurance per day for days 61 to 90, and $682 coinsurance per day for days 91 and beyond. Note that each beneficiary has 60 “lifetime reserve days,” and once that limit is reached, the beneficiary will be responsible for all hospital-related costs. Lifetime reserve days apply after 90 days are spent in a hospital during each benefit period.
- Medicare Part B (medical insurance): The plan carries a $185 annual deductible.
- Medicare Advantage: Deductibles and maximum out-of-pocket amounts vary, depending on the plan you select.
- Medicare Part D: The maximum limit for a Medicare Part D plan deductible, as set by the United States government in 2019, is $415 per year. Most Medicare Part D drug plans place a limit on how much they will spend on drugs in one year. For 2019, once you and your plan have spent $3,820 on prescription drugs, you will have reached the coverage gap, during which you will have to pay 25% of your plan’s cost for covered brand-name prescription drugs and 37% of the price for generic drugs.
Medigap costs for 2019
Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Most U.S. states offer 10 standardized Medicare Supplement plans, each with different premiums and deductibles, and offering various levels of health insurance coverage. Note that Wisconsin, Minnesota, and Massachusetts offer a different set of standardized Medicare Supplement plans. Here’s a look at certain Medicare Supplement plan-related costs for most US states in 2019:
- Medigap Plan N: $50 copayment for emergency room visits
- Medigap Plan N: $20 copayment for doctor’s visits
- Medigap Plan K: $5,560 out-of-pocket yearly maximum
- Medigap Plan K: 50% cost-sharing
- Medigap Plan L: $2,780 out-of-pocket yearly maximum
- Medigap Plan L: 75% cost-sharing
- Medigap Plan F: $2,300 yearly deductible
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