Medicare costs: Key takeaways
When it comes to determining which Medicare coverage is right for your situation, there’s a long list of factors that you can and should consider.
But the actual costs of coverage are critical to consumers – and like most products and services, they change from year to year. Here’s a quick guide to what Medicare beneficiaries can expect in 2019 for each type of Medicare coverage.
[Note that while Medicare Advantage enrollees are still responsible for the Part B premium, the plan design and cost-sharing structure will be different under a Medicare Advantage plan; the following details for out-of-pocket costs under Medicare Parts A and B are specific to people who have Original Medicare.]
Medicare Part A (inpatient care)
2019 Part A premium
- No premium – for most beneficiaries who paid into Medicare through payroll taxes
- $240/month – for those who worked / paid into Medicare between 7.5 and 10 years
- $437/month – for those with a work history of less than 7.5 years
2019 Part A deductible
- Covers up to 60 days in the hospital
- Deductible is per benefit period, NOT per year. Once a beneficiary has been out of the hospital for at least 60 days, a new benefit period would start if and when they needed to be hospitalized again.
- Supplemental coverage, including Medigap plans, will pay some or all of the Part A deductible on your behalf.
- $341 per inpatient day (days 61-90 in the benefit period for which the deductible applied)
- $682 per inpatient day for day 91 and beyond during the benefit period — these are your lifetime reserve days, and you only get 60 of them over the course of your lifetime. They only start to be used up once you’ve spent 90 days in the hospital during a single benefit period. But if you do use up all your lifetime reserve days and don’t have supplemental coverage, you’re responsible for all hospital costs after the lifetime reserve days are used up.
- Medicare Part A covers 100 percent of the cost of skilled nursing facility care for the first 20 days, as long as you had at least a three-night inpatient hospital stay prior to the skilled nursing facility stay. After the first 20 days, your skilled nursing facility coinsurance in 2019 will be $170.50 per day for days 21-100 (after that, Medicare no longer covers skilled nursing facility charges, so you’ll pay the full cost).
- Supplemental coverage, including Medigap plans, is designed to pay the Part A coinsurance on your behalf. And all of the standardized Medigap plans will also pay for up to 365 additional days in the hospital after Medicare benefits are exhausted. Most Medigap plans also cover at least a portion of skilled nursing facility coinsurance costs.
Learn more about Medicare Part A.
Medicare Part B (outpatient care)
2019 Part B premiums:
- The Part B premium for 2019 is $135.50/month for almost all enrollees.
- High-income enrollees pay a higher Part B premium.
- Part B premiums are also higher (due to a penalty) for some beneficiaries who delayed enrollment.
2019 Part B deductible:
- Enrollees who receive treatment during the year must pay the Part B deductible, which is $185 in 2019.
- Medigap plans C and F will pay the Part B deductible for you, but they’ll no longer be available for newly-eligible Medicare enrollees to purchase after the end of 2019.
Part B coinsurance:
- Once you’ve paid your Part B deductible, you’ll be responsible for 20 percent of the Medicare-approved amount for the Part B services you receive, and there’s no limit on how high your coinsurance bills can get. But Medigap plans cover some or all of the Part B coinsurance.
- If your doctor doesn’t accept assignment, they can charge you up to an additional 15 percent.
Learn more about Medicare Part B.
- The average Medigap Plan F cost $143/month in 2018, although the cost varied from one location to another (there are nine other standardized Medigap plan options with premiums that vary from one insurer to another, although not all plan designs are available in all areas).
Medigap out-of-pocket costs
- The out-of-pocket costs you’ll pay after your Medigap plan pays its share will depend on the plan design you select.
Medicare Part C (Medicare Advantage)
2019 Medicare Advantage premiums:
- Part B premium ($135.50 in 2019) + Medicare Advantage premium
- The average premium for Medicare Advantage plans with integrated Part D coverage is about $40/month in 2019.
2019 Medicare Advantage maximum out-of-pocket:
- $6,700 (does not include prescription drug costs)
Learn more about Medicare Advantage.
Medicare Part D prescription drug coverage
2019 Part D premiums:
- The average premium for a stand-alone Medicare Part D plan – including basic and enhanced plans – is about $41/month in 2019.
- High-income enrollees pay a higher Part D premium.
Part D deductible:
- Maximum of $415 in 2019 (some plans have no deductible at all)
Part D out-of-pocket costs after deductible:
- Not to exceed 25 percent of the cost of brand-name drugs and 37 percent of the cost of generic costs
- After a beneficiary’s costs reach the catastrophic coverage threshold, additional out-of-pocket costs are capped at the greater of 5 percent of the cost of the drug or a copay of $3.40 for generics and $8.50 for brand-name drugs.
Learn more about Medicare Part D.
Medicare Extra Help
Medicare Extra Help beneficiary 2019 co-pays:
- $3.40 for generics, $8.50 for brand-name drugs
Learn more about Medicare Extra Help.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.