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 explained
Medicare Advantage vs. Medicare Supplement plansLet’s look at the numbers
Medicare costs terms explained
Whether you’re new to Medicare or could use a refresher, here are some common Medicare terms explained:
Coinsurance is a percentage of your medical and drug costs you may be required to pay as your share of costs for medical services or supplies (for example, 20% of the cost of a prescription drug).
Copayment is a specific dollar amount you may be required to pay as your share of the cost for medical services or supplies (for example, a $10 copay for a healthcare provider visit).
Deductible is the amount you pay for medical services or prescription drugs in a plan year before your plan begins to pay for benefits.
Premium is the amount you are required to pay each month to Medicare or your private insurer for your healthcare coverage.
To learn more, check out our list of definitions for common Medicare terms
How much does Original Medicare Part A cost?
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 generally don't pay a monthly premium for Original Medicare Part A because they paid Medicare taxes while they were working. However, there are costs you may have to cover.
Other Part A costs for 2023:
- An annual deductible of $1,600 in 2023 for in-patient hospital stays
- $400 per day coinsurance payment in 2023 for in-patient hospital stays for days 61 to 90
- After day 91 there is a $800 daily coinsurance payment in 2023 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.
- 20% copay for Medicare-approved durable medical equipment (DME).
- Room and board costs for hospice care in your home or in a nursing home if that is where you live.
- $200 coinsurance payment in 2023 for days 21 to 100 for a skilled nursing facility stay
- All costs after day 100
- 20% copay for mental health services connected with a hospital stay.
How much does Original Medicare Part B cost?
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 2023 Medicare members must pay a monthly premium of $164.90
- 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.
- Your Part B premium could be higher depending on your income.
Your Part B premium could be higher depending on your income.
Other Part B costs for 2023:
- There is a $226 annual deductible for Medicare Part B in 2023. 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.
How much does Medicare Part C (Medicare Advantage) cost?
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.
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 premiums plus a variety of coverages and benefits not offered by Original Medicare (Medicare Parts A and B).
How much does Medicare Part D (prescription drug coverage) cost?
What it helps cover:
- Medicare Part D helps cover prescriptions drugs.
- Plan premiums, the drugs that are covered, deductibles, coinsurance and copays will vary by Part D plans, 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 Part D 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.
- Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2023) times the number of full, uncovered months you didn't have Part D or creditable coverage.
- This penalty is assessed when you enroll in a Part D plan, and you’ll pay the higher amount for as long as you keep your Part D coverage.
- Your Part D premium could be higher depending on your income.
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