Premiums and Deductibles in Medicare | What Do I Need to Know?
While it’s a relief to get Medicare when you turn 65, Medicare is not free. You may have to pay Premiums or Deductibles1. A premium is a monthly payment; a deductible is an annual amount you pay before your coverage kicks in.
As you know, there are four parts to Medicare – A, B, C, and D. If you are enrolled in a Part C (Medicare Advantage) plan, costs and premiums are very different and you can learn more here. Part D, the prescription drug plan, has premiums and deductibles that are described here.
What Are the Premiums of Medicare Part A?
Part A of Medicare, which is usually known as the hospital portion, is premium-FREE for most people. Part A also covers nursing home stays, home health care, and hospice care. If you or your husband worked 40 quarters or more in your lifetime, Part A is automatic and you will pay no monthly premiums2. You can also get premium-free Part A if you already get Social Security benefits or are eligible to get those benefits but have not filed yet3.
If in the case you don’t qualify for premium-free Part A, you can still buy it. In 2021, you will pay between $259 and $471 each month, depending on how many months you paid Medicare taxes. If you choose to buy Part A, you also have to have Part B, which is called the “medical insurance” part of Medicare.
Deductibles of Medicare Part A
Since most people will get Part A without paying premiums, what other costs will you incur for a hospital stay or the other benefits that are part of Part A? Most Medicare Supplemental or Medigap plans pay at least 50% of your hospital deductible, and 100% of your hospital coinsurance, including up to 365 days after your Medicare coverage runs out.
However, if you do not have a Supplemental plan and are only enrolled in Original Medicare without any additional coverage, there will be deductibles and coinsurance for hospital care. $1,484 is the deductible in 2021 when you are admitted to an acute care hospital, long-term care hospital or rehabilitation hospital. Days 1-60 at these facilities will cost nothing during this period. Days 61-90 in a hospital will be $371 per day of each benefit period4. These days with hospital lengths of stay averaging 5.5 days. it is unlikely that you would be in the hospital for more than a week or two, but it is good for you to know what you would pay if you need to stay there longer and do not have Supplemental insurance.
Part A has a late enrollment penalty. If you choose not to enroll but change your mind later, you will pay a higher premium5.
Difference of Medicare Part B Costs
While Part A usually automatically enrolls you, you must actively choose to participate in Part B.
Part B in Medicare is what is usually called the “medical insurance” part because it covers physician services and other outpatient services. Part B has both premiums and deductibles, and the premiums are income-related – that is, you will pay more if you earn more6. If you get benefits from Social Security, your premium will be automatically deducted from your benefit, but you can also choose to pay it in other ways7.
What Will Your Deductibles and Premiums Be for Part B?
The premium charges will be related to your income. Let’s start with the monthly Part B premium. The regular Part B monthly premium for 2021 is $148.50. Most of you will pay that standard amount. Paying more is related to your modified adjusted gross income from two years ago (2019), and that amount goes up with higher income. For example, if you file income of $88,000 or less as an individual, or $176,000 as a couple, you will pay the standard monthly premium of $148.50. If you file between $88,000 up to $111,000 as an individual or $176,000 up to $222,000 as a couple, your monthly premium goes up to $207.90, and so on.
What About Your Part B Deductible?
In 2021, the deductible is $203. It is not income-related. Everyone who has Part B pays the same amount for the deductible. After your costs have reached $203 for a year, you will pay 20% of any remaining costs (and Medicare will pay 80%) unless you have Supplemental (Medigap) coverage. The decision to decline Part B means you will be on your own for any of the costs related to physician services, ambulances, lab work, etc.
Late enrollment in Part B has serious financial implications because you will pay more for your Part B coverage every month you wait. Many Supplemental or Medigap plans cover the Part B deductible. However, monthly premiums are not covered by these plans.
The most important message about costs in Medicare is to enroll when you are eligible. Waiting to enroll until after you are 65 will cost you a lot more.
1Coinsurance is payments shared by you and Medicare on a percentage basis. (Medicare generally pays 80% and you pay 20%). Copays are set fees you pay for doctor visits or prescription drugs. See our page on coinsurance and copays.
2If you work fewer than 40 quarters, your premium will be adjusted based on the quarters for which you paid taxes.
3Premium-free Part A is also available to people who have benefits from the Railroad Retirement Board or Medicare-covered government employment. If you are under 65 you can also get premium-free Part A if you have End-Stage Renal Disease or have had Social Security disability benefits for 24 months.
4Days 91 and beyond will have a $742 coinsurance per each “lifetime reserve day” after 90 days up to 60 days over your lifetime.
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