Overview

Medicare out-of-pocket costs include premiums, deductible, coinsurance and copays. Depending on the plan you choose, you could be on the hook for significant expenses. Out-of-pockets costs vary by plan and can change these every year, so be sure to check your Annual Notice of Change (ANOC).

    Benefit Period

    is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.
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  • Are there out-of-pocket costs for Medicare?

    Short Answer:

    Yes, there are out-of-pocket costs for Medicare. These costs include your monthly premiums, deductibles, and co-pays or coinsurance. The specific amounts you'll pay depend on the type of Medicare coverage you choose and the healthcare services you receive.

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    Here are some costs you can expect to pay:

    Original Medicare (Parts A & B):

    Medicare Part A (hospital insurance):

    • Most people won’t pay a monthly premium for Part A.
    • The Part A deductible is $1,340 for each benefit period.
    • There are no copayments if you're in the hospital or a nursing facility for 60 days or less.
    • Co-pays do apply for lengthier stays. For 2018, the copay is $335 per day from the 61st to the 90th day that you're a patient in a hospital or skilled nursing facility.
    • For stays of more than 90 days, you can reduce your out-of-pockets costs by using some of your lifetime reserve days (under Original Medicare, you get 60 additional days of hospital coverage that you can use, as you choose, over the course of your life). But the co-pay is hefty: $670 per day for 2018.

    Medicare Part B (medical insurance):

    • The standard monthly premium for Part B is $134 in 2018. You may, however, pay more if you have a higher income.
    • The annual Part B deductible is $183 for 2018.
    • Once you reach your deductible you’ll generally be responsible for 20% of your medical costs, while  Medicare covers the remaining 80% percent.

    Medicare Advantage (Part C):

    • The costs for these private plans will vary widely. Some may charge no premium or have a $0 deductible. All plans have limits on out-of-pocket costs.
    • These costs are in addition to your Part B premium, which you must continue to pay.

    Prescription Drug Plans (Part D):

    • If you have a Part D plan, the costs will depend on the specific plan you choose and where you live. You may pay premiums, deductibles, and coinsurance.

    If your income is low, you may qualify for programs that help you pay your health care costs.

  • What is the Medicare Part A deductible?

    Short Answer:

    The Medicare Part A (hospital insurance) deductible is $1,340 per benefit period for 2018.

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    Unlike most insurance, which has an annual deductible, the Medicare Part A deductible covers what’s called a “benefit period,” which starts on the day you’re admitted to a hospital or a skilled nursing facility and end when you haven’t received any hospital or skilled nursing care for 60 consecutive days.

    For 2018, the Medicare Part A deductible is $1,340 for each benefit period.

  • What is the Medicare Part B deductible?

    Short Answer:

    The Medicare Part B (medical insurance) annual deductible is $183 for 2018.

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    You'll have to pay all costs for medical services until you meet the $183 deductible. After that, Medicare generally covers 80% of the Medicare-approved cost of healthcare services, and you're on the hook for the remaining 20%.

    Certain preventive services, like mammograms, cancer screenings, and flu shots, are fully covered under Part B, as long as your doctor or healthcare provider accepts Medicare. That means no copay OR out-of-pocket costs. For a complete list of covered preventive services, check Medicare.gov here.

  • How do I pay my Medicare Part A premium?

    Short Answer:

    Most people don't have to pay a monthly premium for Medicare Part A—the premiums are free if you worked and paid Medicare payroll taxes for at least 10 years during your life or your spouse did. If you or your spouse worked less than that, you will receive a "Medicare Premium Bill" (CMS-500) for Medicare Part A in the mail.

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    If you have to pay a premium for Part A coverage, Medicare will send you a bill on or about the 10th of the month.  You can see an example of the bill here.

    There are four ways to pay your Part A premium:

    • Set up online bill pay with your bank.
    • Pay via Medicare Easy Pay. If you elect this option, the payment will be automatically deducted from your bank account around the 20th of every month.
    • Pay by credit or debit card.
    • Send check or money order to:

    Medicare Premium Collection Center
    PO Box 790355
    St. Louis, MO 63179-0355

  • How do I pay my Medicare Part B premium?

    Short Answer:

    You can pay your Part B premium by mail using a check, money order, or credit/debit card. You can also pay online using Medicare Easy Pay. Details below:

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    To pay by mail:

    Send a check or money order to:

    Medicare Premium Collection Center
    P.O. Box 790355
    St. Louis, Missouri 63179

    If you want to use a debit/credit card to pay by mail, you just need to complete the form at the bottom of your bill and mail it to the Medicare Premium Collection Center.

    To pay online:

    Medicare Easy Pay

    If you enroll in Medicare Easy Pay, your premium payments will be automatically deducted from your savings or checking account each month. You can sign up with this form from Medicare.gov or by calling 1-800-MEDICARE.

    Other:

    If you receive Social Security or RRB benefits, your premium will typically be automatically deducted from these benefits.

    However, some people do get bills from the RRB -- and if that’s the case, you can send payment to:

    RRB Medicare Premium Payments
    P.O. Box 979024
    St. Louis, Missouri 63197

    In some instances,  low income individuals are not required to pay Part B premium, your state will review this every year.

  • What are the Medicare Advantage costs?

    Short Answer:

    Medicare Advantage (Part C) costs vary depending on the plan you choose. Premiums can range from $0 to more than $200 a month, depending on your coverage and the state you live in.

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    Your out-of-pocket costs for Medicare Advantage depend on a few factors:

    • Whether your plan charges a premium
    • If there are deductibles, coinsurance or copayments
    • If the plan includes additional benefits beyond what's included in Original Medicare, such as dental or vision services.
    • The plan’s annual limit on out-of-pocket costs
    • Whether your plan allows you to see out-of-network providers

    It makes sense to consider all of these costs before choosing a plan.

    Once enrolled, review your plan’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) documents, which detail the coverage you have, your expected costs, and more. These costs can change each year, and your plan will notify you of any changes in your ANOC.

    One other thing to note: even if you have a Medicare Advantage plan that doesn’t charge a premium, you still have to pay the Medicare Part B premium each month.

  • What is the out-of-pocket maximum for Medicare Advantage?

    Short Answer:

    The maximum amount you can pay in a given year depends on which Medicare Advantage (Part C) plan you choose. Medicare sets an upper limit, currently $6,700 for in-network expenses and $10,000 for out-of-network expenses. But individual plans can set lower limits and many do.

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    Medicare Advantage (Part C) plans have annual limits on out-of-pocket costs, but these vary widely among plans. They can also change each year.

    Before you choose a plan, find out the annual limit. If you’re already enrolled in a Medicare Advantage plan, read the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) documents your plan provides for specific information on the maximum you can pay out of pocket.

  • Will Medicare pay for dentures?

    Short Answer:

    No, Medicare will not pay for dentures. Original Medicare (Parts A & B) and Medicare Supplement (Medigap) plans won’t cover care that’s not “medically necessary”—and most routine dental care falls into that category.

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    Dentures aren't the only dental work that Original Medicare doesn't cover. It also doesn't provide coverage for routine preventive dental care, such as checkups, cleanings, and fillings, either.

    That said, many Medicare Advantage (Part C) plans do include dental coverage that will pay for dentures as well as routine care. In addition, a few Medicare Supplement plans provide dental coverage, though that is rare. If you’re on Medicaid, dentures may also be covered in some states.

    You can also find affordable, stand-alone private dental plans here.

  • Does Medicare Part B cover eye exams?

    Short Answer:

    No, Medicare Part B (medical insurance) does not cover routine eye exams. However, there are exceptions for people who have diabetes, glaucoma, and macular degeneration.

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    While Medicare Part does not routinely cover eye exams, exceptions are made if you have one of the following conditions:

    • Diabetes: If you have diabetes, you are covered for one eye exam per year.
    • Glaucoma: People who are at a high risk for glaucoma are allowed one glaucoma test a year.
    • Macular degeneration: People with age-related macular degeneration will be covered for certain tests and treatments of the disease.

    These services are covered up to 80% of the Medicare-approved amount by Medicare Part B (medical insurance); you’re responsible for covering the remaining 20%.

    Non-routine eye care is typically covered as well. That means things like cataract surgery, and other types of treatment specifically for eye conditions and diseases. In some cases (like cataract surgery), Medicare will also pay for corrective eyeglasses or contact lenses after the surgery.

    Finally, while Medicare Part B and Medicare Supplement (Medigap) plans do not cover routine eye care, there are some Medicare Advantage (Part C) plans that do.

    Another option: Many insurance companies offer stand-alone vision plans that cover eye exams, glasses and contact lenses, and more.

  • Does Medicare pay for tooth extractions?

    Short Answer:

    No, Medicare does not typically cover tooth extractions unless they are part of a larger medical problem.

    More Info

    While Medicare does not cover dental care that is needed primarily to keep your teeth healthy, it does cover limited dental work needed as part of treated another, Medicare-covered health condition.

    For example, if you need a tooth extraction because of an underlying disease or injury, you’re covered.

    And if a tooth extraction is performed in a hospital as a part of another covered service, it’s covered as well. Medicare will pay for tooth extractions if, for example, you have oral cancer and extractions are necessary before radiation.

    Medicare Part A (hospital insurance) may cover extractions you get in a hospital, if they’re required before a surgery or organ transplant, or as part of reconstruction of the jaw.

    For non-emergency extractions, you’ll need coverage through either a Medicare Advantage (Part C) plan that includes more than just preventative dental, or through a stand-alone private dental plan to avoid substantial out-of-pocket costs.

    If you don’t have Medicare Advantage, there are other options for low-cost or free dental services, such as Medicaid, dental clinics, community health centers, and dental schools.

    Explore stand-alone private dental plans here.

  • Will Medicare pay for a stair lift?

    Short Answer:

    No, Medicare will not pay for a stair lift, because it is not considered a medically necessary piece of equipment.

    More Info

    Medicare Part B covers medical equipment and supplies that are deemed “medically necessary,” such as wheelchairs and walkers. Unfortunately, a stair lift doesn’t meet that standard.

    If you have difficulty getting up and down stairs, there may be other covered devices that could help. Talk to your doctor or search Medicare-approved medical equipment providers in your area here.

    You may also qualify for occupational therapy that can help with mobility issues, as part of Medicare Part B’s covered home health services, click here to learn more.

    Note: A recent rule change affecting Medicare Advantage only could lead some of these plans to offer coverage for stair lifts to some customers in some areas starting next year.

  • Will Medicare pay for home healthcare?

    Short Answer:

    Under some circumstances, Original Medicare (Parts A & B) will pay for home healthcare, but you need to meet strict eligibility requirements. If you’re eligible, part-time nursing care and physical therapy are completely covered, and medical equipment (up to 80%) may be covered as well.

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    How do you qualify? A doctor must certify that you have difficulty leaving your home because of an illness or injury and you need skilled nursing care, physical or occupational therapy, or speech pathology.

    In addition, the home healthy agency caring for you must be a Medicare-certified provider.

    Even if you qualify, there are strict limits on what Original Medicare will cover. Among the things that are not covered: 24-hour care; meals delivered to your home; personal care, such as help with bathing and dressing, if this is the only care you need; and homemaker services, such shopping and cleaning. In addition, the care and services you receive must be for fewer than eight hours a day, or 28 hours a week (up to 35 hours, in some circumstances).

    Finally, while home healthcare services are 100% covered, medical equipment and supplies are only covered up to 80%.

    Note: the above comments are exclusively about Original Medicare.  Some Medicare Advantage (Part C) plans might cover many or even all of those things mentioned here.