Premiums, deductibles, copays, and coinsurance. That’s what you can expect to pay for your Medicare coverage.
Medicare Part A costs
Most people pay $0 in premiums for Medicare Part A. You may qualify for premium-free Part A if:
- You or your spouse worked for at least 40 calendar quarters while paying Medicare taxes.
- You have already been receiving retirement benefits 4 months before your 65th birthday.
- You are already eligible for retirement benefits, but have not received them yet.
- Had a government job covered by Medicare.
- You have received disability benefits for at least 24 months.
- You have end-stage renal disease (ESRD) and meet the established requirements.
If you or your spouse worked between 30 and 39 calendar quarters, you will pay $259 per month for Part A and if you worked less than 30 calendar quarters, you will pay $471 per month.
Deductibles for Part A in 2021 are $1,484 for each benefit period, which is the time between being admitted as an inpatient and not receiving hospital care for 60 days.
You may owe daily coinsurance if you stay in the hospital for a long time. After 60 days as an inpatient, the daily coinsurance is $371 until the 90th day, when it reaches $742. Once you have used up your 60 lifetime reserve days, you owe all costs. As an inpatient in a skilled nursing facility, you owe $185.50 per day from the 20th to the 100th, then all costs.
Medicare Part B costs
The standard monthly Part B premiums for 2021 are $148.50. If you have a high income, you may be charged an income-related monthly adjustment amount (IRMAA), which will increase your premiums.
The Part B deductible is $203 in 2021. Copays and coinsurance are 20% of the Medicare-approved amount for covered services.
Medicare Advantage costs
Your Medicare Advantage plan will charge premiums, deductibles, copays, and coinsurance, but prices will vary between plans. You can expect to pay higher copays for specialty or emergency services and will pay more in premiums if you choose to purchase additional packages for dental, vision, or hearing care, for example. You will also pay more for services received outside of your plan’s provider network.
With this in mind, some Medicare Advantage plans also have $0 premiums.
Medicare Part D costs
For prescription drug coverage, you will pay monthly premiums, a deductible, and copayments for each drug you fill at the pharmacy. The national base premium is just over $30, but your plan price will vary, as will your deductible.
Your prescription copays are based on a tiered system. Your plan classifies all covered prescription drugs into different tiers based on whether the drug is generic or brand-name, preferred or non-preferred, or specialty (requiring special handling or administration). You will pay lower copays for preferred generic prescription drugs and higher copay for specialty prescription drugs.
If you pay more than $4,130 for prescriptions, you will have to pay 25% of the cost of your prescriptions until you have paid $6,550 out of pocket. These amounts reflect the coverage gap and when catastrophic coverage is reached. Once you pay $6,550, you will pay only small copays for the rest of the year.
To learn more about Medicare plans or how to find cost savings, talk to our Avila Medicare Solutions team.