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What are the premiums and costs of the various parts of Medicare?

En español | Medicare covers a lot of your health care costs, but not all. There are also premiums and other out-of-pocket costs to consider. AARP’s Medicare Question and Answer Tool is a starting point to guide you through some of the more common questions about costs and options for people with limited incomes.

 

 

 

General

 

Q: What does Medicare generally cost?

A: Generally, how much you pay for Medicare depends on: which Medicare plan you choose; how often you go to the doctor or hospital; whether you have other health insurance; and whether you qualify for help with Medicare costs. — Read Full Answer

 

Q: Does Medicare cover all of my health care costs?

A: Medicare does not cover all of your health care costs. Depending on which plan you choose, you might have to share in the cost of your care by paying premiums, deductibles, copayments and coinsurance. — Read Full Answer

 

Q: When do the Medicare premiums and coinsurance rates change?

A: New Medicare premium and coinsurance rates are announced each fall and become effective in January. — Read Full Answer

 

Q: What is a premium?

A: A premium is the monthly amount you pay to Medicare or a private insurance plan for your health care and your prescription drug coverage. — Read Full Answer

 

Q: What is a deductible?

A: A deductible is the amount you must pay for health care or prescriptions before Medicare begins to pay its share. — Read Full Answer

 

Q: What is coinsurance?

A: Coinsurance is the amount you may be required to pay for services after you pay any deductibles. This could be a percentage (such as 20 percent) of the Medicare-approved amount or a fixed dollar amount. — Read Full Answer

 

Q: What is a copayment?

A: A copayment is usually a set amount you pay for each medical service, such as a doctor’s visit, or prescription. — Read Full Answer

 

 

 

Part A Hospital Insurance

  

Q: What is the premium for Medicare Part A?

A: Most people don’t pay a premium for Part A because they already paid for it through payroll taxes while working. — Read Full Answer

 

Q: Is there a deductible for Medicare Part A? If so, how much is the deductible?

A: The 2015 deductible for Medicare Part A is $1,260 for each benefit period. — Read Full Answer

 

Q: How much of hospital costs is covered under Medicare Part A?

A: Nothing for the first 60 days of inpatient care each benefit period. $315 per day for days 61-90 each benefit period (in 2015). $630 per lifetime reserve day after day 90 in a benefit period (in 2015). — Read Full Answer

 

Q: How much of skilled nursing costs are covered under Medicare Part A?

A: Nothing for the first 20 days in inpatient care each benefit period. $157.50 per day for days 21-100 each benefit period (in 2015). Costs are for Original Medicare. — Read Full Answer

 

 

 

Part B Medical Insurance

 

Q: What is the premium for Medicare Part B?

A: The standard Part B premium is $104.90 in 2015. Part B helps pay for doctors' services and outpatient care. It also covers other medical services, such as physical and occupational therapy, and some home health care. — Read Full Answer

 

Q: I have Original Medicare. What are the costs for Part B?

A: The Part B costs for Original Medicare are as follows: Premium - $104.90 per month (in 2015); Deductible - $147 per year (in 2015); and Coinsurance - 20 percent for most services Medicare Part B covers. — Read Full Answer

 

 

 

Part D Prescription Drug Coverage

 

Q: What are the costs for Medicare Part D?

A: Medicare Part D plans set their own premiums, drug prices and per-prescription costs. These costs will vary from plan to plan. — Read Full Answer

 

Q: Will my Part D premiums increase because of my income?

A: If your income level is higher than $85,000 for a single person or $170,000 for a married couple filing a joint tax return, you will pay higher Part D premiums. — Read Full Answer

 

Q: What options do I have for paying my Medicare Part D drug plan premiums?

A: You should check with your plan, but most plans allow you to mail in payments or arrange for direct payment made from your bank account or credit card. — Read Full Answer

 

 

 

Premiums

Q: Which tax year will Social Security use to determine my income-related Part B and Part D premiums?

A: To determine your Medicare Part B premium or Medicare prescription drug coverage income-related adjustment amount, Social Security uses your most recent federal tax return information. — Read Full Answer

 

 

 

Penalties

 

Q: How much is the late enrollment penalty for Part A?

A: If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10 percent. — Read Full Answer

 

Q: How much is the late enrollment penalty for Part B?

A: Generally, a 10 percent premium penalty will be added to the Part B monthly premium for each 12-month period you could have enrolled but did not. — Read Full Answer

 

Q: How much is the late enrollment penalty for Part D?

A: Generally, a penalty of 1 percent per month will be added to the Part D monthly premium for each month you could have enrolled but did not enroll or have coverage at least as good as Medicare’s, also known as “creditable coverage.” — Read Full Answer

 

 

 

Help for People with Limited Incomes

 

Q: I heard that you can get help paying the costs of Medicare if you have a limited income. Is this true?

A: Yes, people with limited incomes and resources may be eligible for help paying their Medicare premiums, deductibles and cost sharing. — Read Full Answer

 

Q: Can I get help to pay for my Medicare prescription drugs if I have a low income?

A: Yes. The program that helps people with Medicare who have a low income pay for their prescription drugs is called the Extra Help program. — Read Full Answer

 

Q: Is there a time limit when I can sign up for Extra Help with Medicare prescription drug plan costs?

A: You can apply any time, but you should apply as early as possible. — Read Full Answer

 

Q: If I apply for the Extra Help with Medicare prescription drug costs and am approved, will I be automatically enrolled in a Medicare prescription drug plan?

A: Only if you do not enroll on your own. If you do not enroll on your own, the Centers for Medicare & Medicaid Services (CMS) will send you a letter that will tell you which plan you have been enrolled and how to change plans. — Read Full Answer

 

 

 

Bills and Claims

 

Q: Is my doctor required to file my Medicare claims or do I file claims with Medicare directly?

A: Generally, providers who accept Medicare are required by law to file Medicare claims for covered services for people with Medicare. — Read Full Answer

 

Q: Will my Medicare Prescription Drug Plan notify me if its list of covered drugs (formulary) changes?

A: If you are taking the drug, Medicare requires your plan to notify you 60 days prior to the change or, at the time of refill, provide you a 60-day supply, if prescribed. — Read Full Answer

 

 

 


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