Does Medicare cover all my health care costs?

What are the costs for Part B doctor, outpatient services?

Medicare Part B helps pay for doctor visits, diagnostic screenings, lab tests, preventive care, medical equipment, transportation and other outpatient services.

Premiums. Most people pay $164.90 a month in 2023 for Medicare Part B premiums. People who are single with an adjusted gross income of more than $97,000, or married filing jointly with income greater than $194,000, pay a high-income surcharge, with premiums ranging from $230.80 to $560.50 a month, depending on income level.

If you don’t enroll in Medicare when you are first eligible or qualify for a special enrollment period to sign up later, you also may have to pay a late enrollment penalty, which is added to your Part B premiums for as long as you have the coverage.

Deductible. You’ll have to pay $226 in 2023 before most Part B coverage begins.

Coinsurance. After paying the deductible, you generally pay 20 percent of the Medicare-approved amount, called coinsurance, for most doctor and outpatient services and for durable medical equipment. Part B covers some preventive services without a deductible or coinsurance.

What are the costs for Part C, Medicare Advantage?

Premiums. If you decide to get your Medicare coverage through a private Medicare Advantage plan instead of original Medicare, you still must pay the monthly premiums for Part B — and Part A if you don’t qualify for premium-free part A. Some Medicare Advantage plans also charge an average of $18 a month, although two-thirds of the plans have no additional premium.

Deductibles and copayments. Medicare Advantage plans must provide at least as much coverage as original Medicare, but the deductibles and copayments can be different and vary by plan. All Medicare Advantage plans have an annual cap on out-of-pocket expenses for services covered under Part A and Part B.

The out-of-pocket limit for Part C plans in 2023 is $8,300 or less for in-network health services and $12,450 or less for in-network and out-of-network services combined. Some plans have lower spending ceilings.

Most Medicare Advantage plans also provide prescription drug coverage. And many provide some coverage for hearing, vision and dental care too.

What are the costs for a Part D prescription drug plan?

Premiums. Medicare doesn’t automatically cover prescription drugs, but you can buy a Part D plan from a private insurer. These plans charge a monthly premium that varies by plan, averaging $31.50 in 2023.

People with higher incomes pay a surcharge that adds $12.20 to $76.40 to their monthly bills. If you don’t sign up for a Part D plan when you’re first eligible and don’t have other similar drug coverage, you may also have to pay a late-enrollment penalty.

Deductible, copayments, coinsurance. Part D plans can have a deductible of up to $505 in 2023, and you’ll have copayments or coinsurance for your drugs, based on the plan, the medication and how much you’ve spent so far on prescriptions during the year.

These out-of-pocket costs can vary a lot depending on the plan, and also can change from year to year, making it important to compare your options during open enrollment each year. If you have expensive prescriptions, be aware that you could fall into a coverage gap when you and your insurer have paid $4,660 total for your medications in 2023. You must pay up to 25 percent of the cost of covered drugs in the gap. After you've spent $7,400 from your own pocket, you will then pay a nominal amount for each of your drugs.

Keep in mind

If you have original Medicare, you may be able to cover many of the out-of-pocket costs for Part A and Part B by buying a Medicare supplemental policy, better known as Medigap, from a private insurer. For example, Medigap Plan G covers almost all of Medicare’s deductibles except for the Part B deductible.

But you’ll pay for expenses that Medicare doesn’t cover, such as most dental, hearing and vision care.

If you choose a Medicare Advantage plan instead of original Medicare, the plan may have different copayments and deductibles than Medicare, and its network of doctors and other health care providers usually is limited. But the plan may include some benefits not part of original Medicare, such as dental, hearing and vision care. These benefits come with their own deductibles and copays.

Financial assistance is available at both the federal and state levels for those who cannot afford all the costs associated with Medicare.

Updated December 28, 2022