Costs

Click on each item below to view the basic costs for individuals with Medicare.  If you want specific cost information (like whether you have met your deductible, how much you will pay for an item or service you receive, or the status of a claim), visit MyMedicare.gov.
Medicare Part A (Hospital Insurance)
  • Most people will receive premium-free Part A if they or their spouse have worked more than 40 quarters (10 years).
  • If you have worked 30-39 quarters, your premium for Part A will be $236 per month.
  • If you worked less than 30 quarters (7 1/2 years), your premium will be $426 per month.

Late enrollment penalty:

  • If you do not enroll when you are first eligible, your monthly premium may go up 10%.  You will have to pay the higher premium for twice the number of years you could have had Part A, but did not sign up.)

Part A costs if you have Original Medicare Note – All Medicare Advantage Plans must cover these services.  If you are in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those in Original Medicare.

  • Home Health Care
    • $0 for home health care services
    • 20% of the Medicare-approved amount for durable medical equipment
  • Hospice care
    • $0 for hospice care.
    • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home.  In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it is covered under Part D.
    • You may need to pay 5% of hte Medicare-approved amount for inpatient respite care.
    • Medicare does not cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • Hospital inpatient stay
    • $1,216 deductible for each benefit period.
    • Days 1-60: $0 coinsurance for each benefit period.
    • Days 61-90: $304 coinsurance per day of each benefit period.
    • Days 91 and beyond: $608 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond lifetime reserve days: all costs.

Note: You pay for private-duty nursing, a television, or a phone in your room.  You pay for a private room unless it’s medically necessary. Benefit Period: A benefit period begins the day you are admitted as an inpatient in a hospital or a skilled nursing facility.  The benefit period ends when you have not received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.

  • Mental health inpatient stay
    • $1,216 deductible for each benefit period.
    • Days 1-60: $0 coinsurance for each benefit period.
    • Days 61-90: $304 coinsurance per day of each benefit period.
    • Days 91 and beyond: $608 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond lifetime reserve days: all costs.
    • 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you are a hospital patient.

Note: There is no limit to the number of benefit periods you can have when you get mental health care in a general hospital.  You can also have multiple benefit periods when you get care in a psychiatric hospital.  Remember, there is a lifetime limit of 190 days.

  • Skilled nursing facility
    • Days 1-20: $0 for each benefit period.
    • Days 21-100: $152 coinsurance per day of each benefit period
    • Days 101 and beyond: all costs
Medicare Part B (Medical Insurance)
  • Monthly premium

Most people pay the Part B premium of $104.90 per month. However, if your modified adjusted gross income as reproted on your IRS tax return from 2 years prior is above a certain amount, you may pay more. PartB-Cost

  • Late enrollment penalty:

If you do not sign up for Part B when you are first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare.  Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but did not sign up for it. Part B costs if you have Original Medicare Note: All Medicare Advantage Plans must cover these services.  If you are in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those in Original Medicare.

  • Part B annual deductible:

You pay $147 per year for your Part B deductible

  • Clinical laboratory services:

You pay $0 for Medicare-approved services.

  • Home Health Services
    • $0 for home health care services.
    • 20% of the Medicare-approved amount for durable medical equipment
  • Medical and other services:

You pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you are a hospital inpatient), outpatient therapy, and durable medical equipment. Note: In 2014, there may be limits on physical therapy, occupational therapy, and speech language pathology services.  If so, there may be exceptions to these limits.

  • Outpatient mental health services
    • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
    • 20% of the Medicare-approved amount for visits to a doctor or other health care provider to diagnose or treat your condition.  The Part B deductible applies.
    • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.  This amount will vary depending on the service provided, but will be between 20-40% of the Medicare-approved amount.
  • Partial hospitalization mental health services:

You pay a percentage of the Medicare-approved amount for each service you get from a doctor or certain other qualified mental health professionals if your health care professional accepts assignment.  You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B deductible applies.

  • Outpatient hospital services
    • You generally pay 20% of the Medicare-approved amount for the doctor or other health care provider’s services, and the Part B deductible applies.
    • For all other services, you also generally pay a copayment for each service you get in an outpatient hospital setting.  You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor’s office.
    • For some screenings and preventive services, coinsurance, copayments, and the Part B deductible do not apply (so you pay nothing).
Medicare Part C (Medicare Advantage)
  • Monthly premium:

The Part C monthly premium varies by plan.

Medicare Part D (Prescription Drug Coverage)
  • Monthly premium:

The Part D monthly premium varies by plan (higher-income consumers pay more). The chart below shows your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return from 2 years prior.  If your income is above a certain limit, you will pay an income-related monthly adjustment amount in addition to your plan premium.

  • Late enrollment penalty:

If you do not sign up for Part D when you are first eligible or if you drop Part D and then get it later, you may have to pay a late enrollment penalty for as long as you have Part D.  The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.

We’d love to hear from you

Contact Us

Recent News

Common ERISA Penalties by the DOL – 2017

The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.

SPD Requirements – Erisa Wrap Compliance

The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.