The Medicare program offers many benefits to people who want to get affordable health care during their retirement.
But more often than not, people aren’t aware of the costs they will have to pay when they sign up or go to the hospital.
Whether you’re signing up for Medicare or buying a Medicare Supplement Plan, knowing how much your cover might cost can save you from surprises in the future.
This article will explain what you can expect to pay when you enroll in Medicare and what your coverage will cost each time you use your Medicare benefits.
Medicare costs, terms, and conditions can be confusing. That’s why we’ve created this overview of common Medicare costs and expenses to help you understand what everything means.
Medicare is a health program administered by the United States government for people turning 65 and older, those with disabilities, and individuals who suffer from ESRD (End-Stage Renal Disease).
There are three parts or sections to Medicare (Part A, Part B, and Part D) which cover different types of medical expenses such as inpatient treatment, outpatient medical expenses, and prescription drugs.
There are also different types of health insurance plans such as Original Medicare, and other health insurance options such as Medicare Advantage, Medicare Part D plans, and Medicare Supplement Insurance plans.
When you join a Medicare plan, you’ll have to pay two kinds of expenses: premiums and, in some cases, late enrollment penalties.
Medicare premiums are the monthly costs you have to pay to be a member of Original Medicare (Part A and B), Medicare Advantage, Medicare Supplement Insurance, or a Part D plan.
Late enrollment penalties are fees you will have to pay if you decide not to enroll in Medicare when you are eligible. These fees are different for Part A and Part B.
Once you’re enrolled and begin using your Medicare health insurance, there will be costs you’ll pay for medical treatment, tests, or services. These are known as deductibles, coinsurance, copayments, and out-of-pocket costs.
Deductibles are amounts that you have to pay for your prescriptions and healthcare before your Medicare policy starts to pay for your healthcare expenses. These are fixed amounts that are set by Medicare every year.
Coinsurance payments are the portion of the Medicare cost that patients pay for medical treatment, services, and items. These expenses are different for Medicare Parts A and B and can either be a percentage of the costs or based on days of treatment.
Copayments are fixed amounts that you pay for a medical service, test, or item. These are set by your health insurance provider and range in cost depending on the type of expense. For example, a visit to the doctor might have a copayment of $25.00.
Out-of-pocket expenses are costs that Medicare doesn’t cover. This means you will have to pay for these expenses yourself. Deductibles, coinsurance, and copayments are all examples of out-of-pocket Medicare-approved expenses.
Medicare Part A covers inpatient treatment and services. If you’re admitted to the hospital, the costs of your care will fall under Part A.
You can get Part A coverage through Original Medicare or Medicare Advantage. If you haven’t signed up for Medicare Part A, here are some Medicare costs that you should consider.
If you or your spouse paid Medicare taxes through your payroll taxes for at least forty quarters (ten years), you‘ll be able to sign up and get Part A cover for free. This is called “Premium-Free Part A.”
However, if you haven’t paid Medicare taxes you will have to pay monthly Medicare premiums to join the program.
Here’s an overview of what you might expect to pay based on your previous Medicare tax contributions.
|Medicare Part A Contributions and Premiums||Cost|
|At least 40 quarters||Free (no monthly premium)|
|Less than 39 quarters||$259.00 per month|
|Less than 30 quarters||$471.00 per month|
|No contributions towards Medicare||Up to $471.00 per month|
This monthly premium is based on your total contributions, and you will have to pay this amount if you want to stay on Medicare Part A.
If you need help finding out about your contribution status and want to know what steps you can take to minimize your monthly Part A costs, reach out to PolicyScout for assistance.
If you have premium-free Medicare Part A, you will be able to enroll at any time without having to pay a penalty.
But if you haven’t contributed towards Medicare for at least forty quarters and don’t sign up during your Initial Enrollment Period, you will have to pay a late enrollment penalty on top of your monthly premium.
The late enrollment penalty can make your monthly premium go up by 10%, and you will have to pay this for twice the number of years you didn’t enroll. For example, if you weren’t enrolled in Part A for two years, you would have to pay the Late Enrollment fee for four years.
If you’ve contributed toward Medicare for 36 quarters (around nine years), you’ll have to pay $259.00 per month to get Part A cover.
If you delay your enrollment for three years after you become eligible, you’ll have to pay 10% on top of this amount ($259.00 +10%).
This would mean you would have to pay $284.90 every month for six years.
With Medicare Part A, your coverage is divided up according to benefit periods. Benefit periods define when your Part A cover kicks in and when it stops.
A benefit period starts on the day you are admitted to the hospital. It ends after 60 days if a person doesn’t receive treatment as an inpatient.
For each benefit period, there is a deductible cost. This amount is set at $1,556.00 for 2022.
It’s important to remember that:
You can have multiple benefit periods in one year.
You can also have one benefit period that includes more than one hospitalization.
Different illnesses do not affect benefit periods.
You’ll have to pay your deductible cost for each benefit period.
Example of One Benefit Period
You are hospitalized for twelve days in January and released but readmitted 20 days later for a different condition.
In this case, you are still in the same benefit period and do not have to pay a deductible for your second hospitalization.
Example of Two Benefit Periods
You are hospitalized in January for ten days and again in November for twenty days.
In this case, 60 days have elapsed between your first and second hospitalization. You’ll have to pay two deductibles for the two separate benefit periods.
Coinsurance amounts for Medicare Part A are based on the number of days you spend in the hospital.
You will be covered for the first 60 days of your hospital stay, which means that you won’t have to pay for Part A costs after you pay your benefit period deductible.
After 60 days you will have to pay a coinsurance amount for each day you spend in the hospital.
|1-60||$0 per day|
|61-90||$371 per day|
|91 and beyond||$742 per day|
Unlike Part A, there is no free option with Medicare Part B and you will have to pay a monthly premium to get coverage.
Your Medicare Part B premiums will depend on many factors and can vary from person to person. But you won’t have to pay thousands of dollars each month to enroll. The standard premium amount for Part B in 2022 is $170.10.
However, if you are in a higher tax bracket you might have to pay more for Part B cover. This is because monthly Part B premiums are calculated using your yearly income and an Income Related Monthly Adjusted Amount (IRMAA).
Figuring out what you might expect to pay can be difficult as the IRMAA is based on your previous tax returns and filing status.
Take a look at the table below to get an idea of what you might pay for Part B cover in 2022.
|File individual tax return||File joint tax return||File married & separate tax return||You pay each month (in 2022)|
|$91,000 or less||$182,000 or less||$91,000 or less||$170.10|
|above $91,000 up to $114,000||above $182,000 up to $228,000||Not applicable||$238.10|
|above $114,000 up to $142,000||above $228,000 up to $284,000||Not applicable||$340.20|
|above $142,000 up to $170,000||above $284,000 up to $340,000||Not applicable||$442.30|
|above $170,000 and less than $500,000||above $340,000 and less than $750,000||above $91,000 and less than $409,000||$544.30|
|$500,000 or above||$750,000 or above||$409,000 or above||$578.30|
If you decide not to join Part B once you become eligible at the age of 65, you might have to pay a late enrollment fee.
The penalty is usually 10% of your monthly Part B premium and is calculated on the amount of 12-month periods you weren’t enrolled in. You will also have to pay this amount for as long as you have Part B coverage.
For example, if you sign up for Part B coverage three years (3 x 12 month periods) after you become eligible, you will have to pay a 30% penalty on top of your monthly Part B premium.
Medicare Part B benefit periods are annual and you will have to pay your deductible each year if you want to be covered by Part B.
Your Part B deductible payment will be $233.00 for 2022. This deductible resets every year on January 1st.
After you pay your deductible, you will also have to pay 20% of the Medicare-approved amount for Part B expenses.
Outpatient therapies, like physical therapy and occupational therapy.
Durable medical devices and equipment (wheelchair, hospital bed).
For example, if it costs $160.00 to see your local doctor, Medicare will pay 80% ($128.00) and you will need to pay 20% ($32.00).
Medicare-approved amounts, also known as “assignments”, are the amounts that Medicare is willing to pay for medical expenses.
Sometimes doctors’ or medical professionals’ services cost more than Medicare is willing to cover. In these cases, you will have to pay the difference on top of your 20% coinsurance amount.
But medical professionals can only charge up to 15% more than the Medicare-approved amount for services if they accept a Medicare patient.
An alternative to Original Medicare is Medicare Advantage. These are private health care plans that cover medical insurance (Part B), hospital insurance (Part A), and prescription drug coverage (Part D).
Your Medicare Advantage monthly premium will depend on the type of plan you choose, your location, and your health insurance provider.
Prices for your Medicare Advantage premium can vary between $0 to $100 or more a month, with the average premium amount in 2021 being $21 per month.
The Kaiser Family Foundation estimates that 65% of enrollees don’t pay any monthly premium, and only 5% of people pay $100 or more per month.
Some Medicare Advantage plans have a deductible cost which you will have to pay before your policy starts to cover you.
However, many plans offer a $0 deductible, which means you will not have to pay a deductible cost before you get cover for Part A and Part B expenses.
With a Medicare Advantage plan, you might have copayments which are flat fees that you will have to pay for medical services, tests, and treatments. You might also have to pay coinsurance for Part A and B medical costs.
But these costs are usually lower than what you would pay if you were an Original Medicare member.
This is because Medicare Advantage plans contract doctors and medical professionals onto their plans, which helps them to reduce the costs of medical services and treatments for their members.
For example, with a Medicare Advantage plan, your copayment amounts could range between $0.00-$50.00 for doctor’s services. With Original Medicare, you’d have to pay 20% of their fee (Medicare pays for 80% of the cost).
And, if your doctor charged more than Medicare’s approved amounts, you would have to pay the difference on top of your 20% costs.
Your Medicare Advantage provider will let you know what your coinsurance and copayment costs will be before you enroll, but remember that different types of plans offer various benefits.
With the right Medicare Advantage provider, you might lower your overall health insurance costs. To learn more about Medicare Advantage monthly expenses and find out which plan is the best for you, email Help@PolicyScout.com.
Medicare Supplement Insurance Plans, or Medigap policies, are private policies that help with out-of-pocket costs not covered by basic Medicare. Let’s look at some of the expenses you will have to pay for a Medicare Supplement Plan.
Prices for Medicare Supplement Plans vary depending on where you live, your provider, and other lifestyle factors.
Just remember, you will still have to pay your Medicare Part A and Part B premiums each month with your Medicare Supplement Insurance plan. In some cases, your Medicare Supplement Insurance plan might pay for your Part B premium.
It’s always best to speak to providers before you sign up for a plan. If you need further assistance in finding Medicare Supplement Plans in your area, reach out to PolicyScout for help at 1-888-912-2132.
Depending on your Medicare Supplement Insurance Plan, your deductibles for Medicare Parts will be covered.
Some Medicare Supplement Plans cover Part A hospital deductibles, while others do not cover any deductibles at all.
If you’re wondering about which deductibles your plan covers or you want to check if you can get a plan that is more affordable, contact PolicyScout and speak with one of our consultants.
Depending on the type of plan you have, your Medicare Supplement plan will cover coinsurance costs for both Part A and B expenses. This means you won’t have to pay as much as you would if you had Original Medicare.
But the amount of cover you’ll get depends on the plan you have. If you’d like to learn more about coverage, costs, and benefits for different plans, check out our guide to Medicare Supplement Plans.
Medicare Part D Plans help members cover the costs of prescription drugs. These plans are a good choice for people who have chronic conditions or need assistance in paying for medication.
Prescription Drug Plans (Part D) charge a monthly premium for membership. This amount can vary based on your plan, but in 2022 the average premium for a Part D plan was between $5.70 - $205.30 per month.
Your monthly premium will also be adjusted with Medicare’s IRMAA (Income-Related Monthly Adjustment Amount).
Below is a table displaying more information about the Part D monthly premium that takes into account the IRMAA.
|File individual tax return||File joint tax return||File married & separate tax return||You pay each month (in 2022)|
|$91,000 or less||$182,000 or less||$91,000 or less||your plan premium|
|above $91,000 up to $114,000||above $182,000 up to $228,000||not applicable||$12.40 + your plan premium|
|above $114,000 up to $142,000||above $228,000 up to $284,000||not applicable||$32.10 + your plan premium|
|above $142,000 up to $170,000||above $284,000 up to $340,000||not applicable||$51.70 + your plan premium|
|above $170,000 and less than $500,000||above $340,000 and less than $750,000||above $91,000 and less than $409,000||$71.30 + your plan premium|
|$500,000 or above||$750,000 or above||$409,000 or above||$77.90 + your plan premium|
If you enroll late for a Part D plan, you will have to pay this late-enrollment penalty as long as you have Medicare drug coverage.
But your Part D penalty amount will depend on how long you were not enrolled in Part D.
Keep these points about Part D penalties in mind:
You will be informed if you owe a penalty once you join a Medicare drug plan.
The penalty is based on the national base beneficiary premium and the number of months you did not have Part D prescription drug coverage.
For every month you will pay a 1% penalty multiplied by the national base beneficiary premium. In 2022, the national base beneficiary premium was $33.37.
The final penalty amount is rounded off to the nearest $0.10.
Let’s take a step-by-step approach to learn how your Part D late enrollment fee is calculated:
(22% x $33.37= $7.34) 3. The amount will then be rounded to the nearest $0.10. ($7.34 rounded to the nearest $0.10 is $7.30.) 4. Your monthly late enrollment fee would be $7.30 per month for 2022.
Enroll in medicare drug coverage as soon as you are eligible.
Enroll in Medicare drug coverage if you lose other creditable coverage.
Keep records of your previous creditable drug coverage if you had it before enrolling in Medicare.
Part D Plan deductible costs will depend on your provider, your plan benefits, your location, and your plan’s deductible policy.
With some Medicare Part D plans, you might not have to pay a deductible. Some plans offer low deductible options, while other providers offer a high deductible plan for some of their members.
It’s always best to shop around for a plan that suits your financial situation and can offer you the coverage you need.
If you’re looking to purchase a Part D plan or want to switch to a new provider, reach out to PolicyScout’s Medicare consultants for assistance.
Coinsurance amounts for Part D plans vary because they relate to costs that can change (prices of drugs) and other factors.
Your coinsurance costs will depend on:
Your plan’s level or “tier” of coverage for drug brands and costs.
Your medical needs.
Part D plans coinsurance and copayment rates might change when:
Drug prices fluctuate throughout the year.
The brand of medication you use is not on your plan’s approved list (formulary).
New generic drugs are released and your plan includes them.
|Medicare Plan||Monthly Premium (per month)||Late Enrollment Penalties||Deductibles||Coinsurance||Copayments|
|Medicare Part A||$0-$499 (depending on contributions)||Monthly premium increases 10%||$1556||$0-$778||N/A|
|Medicare Part B||$170.10-$578.30 (depending on your income)||Monthly premium increases 10% per 12 month period||$233||20% of Medicare- approved amount||N/A|
|Medicare Part C/Medicare Advantage||$0-$100+ (depending on your plan)||N/A||Plan dependent||20% of Medicare- approved amount||Plan- dependent|
|Medicare Supplement Plan||$50-$300 plus||N/A||Specific Part A deductibles are covered||Specific Part A and Part B coinsurance costs are covered||N/A|
|Medicare Part D||Your Plan Premium - Your Plan Premium + $77.90||1% penalty multiplied by $33.37 for each month you are late||$445 maximum amount||Pay no more than 25% until your out-of-pocket spending is $6,550||Plan- dependent|
If you’re interested in learning more about the federal Medicare program or a particular Medicare cost, check out PolicyScout’s Medicare Hub to get the latest information on Medicare benefits, Medicare Advantage, and Medicare Supplement Plans.
We also have a team of trained Medicare consultants if you’d like to speak with someone about your Medicare options. Contact us at 1-888-912-2132 or send an email to Help@PolicyScout.com to get the help you need.