What are the out-of-pocket costs for Medicare?

Medicare covers a great deal of services, but you can still be left with out-of-pocket costs. Here is what you can expect to pay:

Premiums

Most individuals who become eligible for Medicare qualify for premium-free Part A. If you or your spouse has worked and paid Medicare taxes for at least 10 years, you will have no monthly premium. People who worked and paid these payroll taxes for 30-39 quarters (6-9 years) will pay a rate of $252. If you have not paid Medicare taxes for at least 30 quarters, your monthly Part A premium is $458.

You will pay a monthly premium for Part B. The standard premium amount for 2020 is $144.60. If you make more than $87,000 as an individual or $174,000 as a couple, you will have a higher payment. 

Copayments

With Medicare Advantage plans, you will often pay copayments when you visit the doctor or have medical appointments. This could be a set amount or a portion of the bill. Some plans have set costs of $20 for doctor visits and $50 for emergency room visits.

Coinsurance

The coinsurance before Part A differs in cost based on the number of days spent as a hospital inpatient for each benefit period. There is no coinsurance for the first 60 days. Days 61 through 90 add a coinsurance of $352 per day of each benefit period. For days 91 and beyond, there is $704 coinsurance per each lifetime reserve day. After a maximum of 60 lifetime reserve days, you pay all costs.

Coinsurance for Part B kicks in after you pay your deductible for the year. You will then pay 20% of the costs.

Deductible

The Part A deductible is $1,408 for each benefit period. Out-of-pocket costs toward hospital inpatient care contribute to this deductible. The standard Part B deductible is $198.

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