While Medicare covers a wide range of medical expenses, seniors enrolled in Medicare still need to pay some out-of-pocket costs. Just as you pay premiums, copays, deductibles, and other costs under your private health insurance coverage, you’ll need to do the same for Medicare.
How much you will pay out-of-pocket during any given year depends to some degree on the specific care and services you need. But you can do some health care planning and budgeting by understanding the typical costs you can expect with Medicare Parts A and B. Knowing how much you will be on the hook for can also help you decide whether you need a private Medicare supplemental insurance plan — also called a Medigap plan — that can cover these costs.
Part A Premiums
While some Medicare enrollees may need to pay a premium for coverage under Part A, 99 percent of people don’t because they have earned at least 40 quarters of Medicare-covered employment. However, if you paid less than 30 quarters of Medicare taxes, the standard Part A premium you will pay in 2023 is $499. If you paid 30-39 quarters worth of Medicare taxes, your 2023 Part A premium is $274.
Part A Hospital Inpatient Deductibles and Coinsurance
Medicare Part A inpatient hospital benefits (including inpatient mental health stays) are subject to a deductible of $1,556 for each benefit period in 2023, which covers the patient’s share of expenses for the first 60 days of an inpatient hospital stay in a given benefit period.
The amount you’ll need to pay in coinsurance for an inpatient hospital stay largely depends on how long you are in the hospital:
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $389 coinsurance per day of each benefit period
• Days 91 and beyond: $778 coinsurance for each “lifetime reserve day” after day 90 per benefit period (up to 60 days over your lifetime)
• After lifetime reserve days: all costs
Hospice Care and Home Healthcare Under Medicare Part A
You pay nothing for home health care services but will be responsible for 20 percent of the Medicare-approved amount for any Durable Medical Equipment (DME) you may need.
Similarly, you won’t pay anything for hospice care, though you may have a copay of up to $5 for any prescription drug and similar pain relief and symptom control products you need while you’re at home.
Medicare Part B Out-Of-Pocket Costs
Medicare Part B covers physician’s visits, preventive care services, outpatient care, and some home healthcare visits.
Part B Premiums
The standard Part B premium amount that most people will pay in 2023 is $170.10. However, if your modified adjusted gross income as reported on your federal tax return from two years ago is above a certain threshold, you’ll pay the standard premium plus an extra Income Related Monthly Adjustment Amount (IRMAA) added to your premium.
Part B Deductibles and Copays
In 2023, the Part B deductible is $233. After meeting your annual deductible, typical copays are 20 percent of the Medicare-approved amount for:
• Most physician services (including most doctor services during inpatient hospital stays)
• Outpatient therapy
• Outpatient mental health services
• Durable medical equipment
No copays apply to clinical laboratory services or home health care services.
To find out the out-of-pocket costs with Medicare for specific treatments, services, tests, or procedures, you can go to the Medicare website and do a search. If you can’t find your test, item, or service, speak with your doctor or other health care provider about why you need the treatment in question and ask if Medicare will cover it.
Contact Every Way Health With Your Medicare Questions
If you have questions about Medicare or need assistance in choosing the Medicare supplemental insurance plan that’s best for you, please get in touch with Every Way Health at 877-460-3943.