Medicare Parts A, B, C and D: Costs and coverage explained

Let’s look at the numbers

There are many different parts of Medicare, each with their own costs and coverage levels. We’ve broken them down for you here to help make them easier to understand.

Medicare Part A – hospital coverage

What it helps cover:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as that isn't the only care you need)
  • Hospice care
  • Home healthcare

What it costs:

  • Most people don't pay a monthly premium for Medicare Part A because they paid Medicare taxes while they were working. However, there are costs you will have to deal with.

Other Part A costs for 2019:

  • An annual deductible of $1,364 for in-patient hospital stays.
  • A $341 per day coinsurance payment for in-patient hospital stays for days 61 to 90.
    • After day 91 there is a $682 daily coinsurance payment for each lifetime reserve day used.
    • After the maximum 60 lifetime reserve days are exhausted, there is no more coverage under Part A for inpatient hospital stays.
  • There is a 20% copay for Medicare-approved durable medical equipment (DME).
  • Medicare does not cover any room and board costs for hospice care in your home or in a nursing home if that is where you live.
  • There is a $170.50 coinsurance payment for days 21 to 100 for a skilled nursing facility stay.
    • After day 100 you are responsible for all costs.
  • There is a 20% copay for mental health services connected with a hospital stay.

Medicare Part B – medical coverage

What it helps cover:

  • Medically necessary doctors' services
  • Outpatient care
  • Medically necessary chiropractic care
  • Home health services
  • Durable medical equipment (DME)
  • Many preventive services

What it costs:

  • Most 2019 Medicare members must pay a monthly premium of $135.50.
  • If you don't enroll in Medicare Part B as soon as you are eligible, you could be assessed a late enrollment penalty when you do enroll.
    • The penalty could be as high as a 10% increase in your premium for each 12-month period that you were eligible but not enrolled.
  • If you earn over $85,000 ($170,000 for joint filers) you’ll pay a higher monthly premium for Part B.

Other Part B costs:

  • There is a $185 annual deductible for Medicare Part B in 2019. After the deductible, you’ll pay a 20% copay for most doctor services while hospitalized, as well as for DME and outpatient therapy.
  • There is a 20% copay of the Medicare-approved amount for doctor visits to diagnose a mental health condition after the deductible.
    • If you receive these services at a hospital outpatient department or clinic, additional copays or coinsurance amounts may apply.
  • There is a 20% copay of the Medicare-approved amount for outpatient services after the deductible.

Medicare Advantage – Part C (through a private insurer)

What it helps cover:

  • Medicare Advantage plans are required by law to provide—at minimum—the same coverage, benefits and rights provided by Original Medicare Part A and Part B, with the exception of hospice care.
  • Many Medicare Advantage plans also choose to offer prescription drug coverage, as well as coverage for routine dental, vision and hearing benefits, to compete for your business.

What it costs:

  • Medicare Advantage plans are offered by private insurance companies contracted by the federal government, so they vary in cost, coverage, deductibles and copays.
  • Many Medicare Advantage plans offer affordable or $0 dollar premiums plus a variety of coverages and benefits not offered by Original Medicare (Medicare Parts A and B).

See costs and coverage for Humana Medicare Advantage plans

Medicare Part D – prescription drug coverage

What it covers:

  • Medicare Part D covers prescriptions drugs.
  • Plan premiums, the drugs that are covered, deductibles, coinsurance and copays will vary by plan, so you should check and compare plans each year based on your needs, the prescription drugs you take, etc.

What it costs:

  • Like Medicare Advantage (Part C), prescription drug plans (Part D) are offered by private insurance companies contracted by the federal government.
    • Plans vary in cost, coverage, deductibles and copays.
  • There’s a late-enrollment penalty if you don’t enroll in an approved Medicare drug plan (including a Medicare Advantage plan) when you’re first eligible, unless you have other creditable prescriptions drug coverage.
    • The penalty for 2019 is the “national base premium,” which is $33.19 per month, times the number of months that you weren’t covered.
    • This penalty is assessed when you enroll, and you’ll pay the higher amount for as long as you keep your Part D coverage.
  • If you earn over $85,000 ($170,000 for joint filers) you’ll pay a higher monthly premium.

See costs and coverage Humana prescription drug plans

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