Plan for Medicare Costs Before You Enroll

Part A Medicare Costs

Part A hospital insurance has $0 monthly premium cost in most cases, but also includes a deductible to meet before coverage begins ($1,484 in 2021). This deductible is NOT annual. It is per benefit period, which means if you have multiple hospitalizations during a year, you might have to pay more than one deductible.

After your deductible, for inpatient hospitalizations you are responsible for a:

• $0 coinsurance payment per day for days 1-60
• $371 per day for days 61-90
• $742 per day for days 91 and beyond

Every day beyond 91 is considered a lifetime reserve day. You get 60 of these.

Part B Medicare Costs

For most people, Part B medical insurance has a standard monthly premium cost of $148.50. However, it could be higher based on income.

You’re responsible for a Part B deductible ($203 in 2021), and after that deductible, for 20% of Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment.

Part C Medicare Costs

Medicare Advantage (Part C) plans vary in costs. These plans wrap up coverage equal to Parts A and B, often include Part D prescription drug coverage, and may include other features, such as dental or vision benefits.^F90  Check specific plans available in your county for details.

Part D Medicare Costs

Prescription Drug (Part D) plans vary in costs. Check specific plans for details.

Your Part D plan may include a deductible to pay before the plan pays anything for prescriptions.  For 2022, $480 is the highest that deductible can be. After you've paid any deductible, your prescription drug coverage breaks down into three phases: 

1. In 2022, in Part D plans, during the initial coverage phase, you pay 25% of the costs of your prescriptions up to a threshold of $4,130 in total prescription drug costs (which is both what you pay and what the plan pays combined).
   
2. After that, you enter what used to be called the coverage gap, or donut hole. That coverage gap closed in 2020. Now, in this coverage phase, you continue to pay 25% of your prescription costs up to a threshold of $5,582.50 in total prescription drug costs (which is a combination of both what you pay and the 70% discount given by drug manufacturers on brand-name prescription drugs during this phase of coverage).
   
3. Once you hit that threshold, you enter the catastrophic benefit period of your coverage.  In this phase, you pay either a 5% coinsurance or a copay ($3.95 for generic drugs, $9.85 for brand or non-preferred drugs). You remain in this phase to the end of the year, December 31.  Your benefits then reset for the next calendar year. 
   

What Doesn't Medicare Cover?

Important: Original Medicare (Parts A and B) doesn’t cover everything. There may be deductibles, copays and coinsurance fees you still have to pay. To more fully protect yourself from large medical costs out of your own pocket, you’ll need Part D Medicare prescription drug coverage and a Medicare Supplement insurance plan or you’ll need to choose a Part C Medicare Advantage plan that wraps up your Parts A, B and often D coverage in one package and includes other benefits that help cover you during those situations when Original Medicare wouldn’t.

If you’re coming straight off many group or private health insurance plans, Medicare may seem like cheap health insurance to you. And in many ways, it’s a great deal. However, as with any insurance coverage, it still pays to really understand your out-of-pocket costs and when you will face them.