Do you have to pay for Medicare, or is it free?
- Most people don’t pay for Medicare Part AMedicare Part A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... (hospital insurance), however you do pay co-insurance and an annual deductible.
- There is a premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ... for Medicare Part BMedicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care..... It also has a deductible and co-insurance.
- After you pay your deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share...., you pay 20% of all Medicare-covered costs. [1]
- Medicare does not pay for dental care or oral surgery [2], vision care [3] , hearing exams or hearing aids [4], or your prescription medications. [5]
Related: Learn about Original Medicare
Medicare Part A Co-payments and Deductibles
Medicare is definitely not free, but it covers quite a bit. As a Medicare beneficiaryA person who has health care insurance through the Medicare or Medicaid programs...., you are responsible for paying co-payments and deductibles, just as you would with traditional health insurance.
As an example, in 2017, beneficiaries with a hospital stay pay:
- $1,316 deductible for each benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit...
- Days 1-60: $0 coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. ... for each benefit period
- Days 61-90: $329 coinsurance per day of each benefit period
- Days 91 and beyond: $658 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve daysThese are additional days that Medicare will pay for when you are in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime....: all costs
If you go to a skilled nursing facility after a three-day stay in the hospital, you’ll pay:
- Days 1–20: $0 for each benefit period.
- Days 21–100: $164.50 coinsurance per day of each benefit period.
- Days 101 and beyond: all costs.
Medicare Part B Co-payments and Deductibles
You pay $183 per year for your Part B deductible. After that you typically pay 20% of the Medicare-approved amount for:
- Most doctor services and lab work
- Outpatient therapy
- Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds....
Medicare Part C Costs
If you opt to exchange your Part A and B benefits for a Medicare AdvantageMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... (Part C) plan, your out-of-pocket costs will depend on:
- Whether the plan charges an additional monthly premium.
- Whether the plan pays any of your monthly Medicare Part B premium.
- Whether the plan has an additional deductible or any additional deductibles.
- How much you pay for each visit or service (copaymentA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.... or coinsurance).
- The type of health care services you need and how often you get them.
- Whether you go to a doctor or supplier who accepts assignmentAn agreement by your doctor to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.... (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).
- Whether you use network providers, if required by the plan.
- Whether you need extra benefits and if the plan charges for it.
- The plan’s yearly limit on your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.... for all medical services.
- Whether you have MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.... or get help from your state.
Medicare Part D Co-payments and Deductibles
Medicare Prescription Drug PlansMedicare Part D is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.... (Part D) also have co-payments and deductibles, and plans have a monthly premium (unless you qualify for Extra Help through SSA). Most plans have a coverage gapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage...., known as the “donut hole”, which begins after a certain level of spending. Within the donut hole, people receive a discount of 50 percent on brand-name drugs. When the end of the coverage gap is reached, there is a 5 percent co-payment on future drug purchases.
Some people enrolled in Medicare purchase Medicare Supplement InsuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage.... (Medigap) policies to help pay the co-payments, deductibles, and other charges under Medicare. For those still working at age 65, or those who are 65 and older and have retiree health insurance, coverage through current or former employers will help pay the bills. The policies (the employer coverage and Medicare) are coordinated to provide the most help with co-payments and deductibles. Medicare does not cover custodial careNon-skilled personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom.... in a nursing home, which can be a major expense after age 65. Only skilled care and rehabilitation services in a nursing home, for medical treatment of an acute illness, are covered.
Related FAQs
Reference
[1] “Medicare-covered” includes most doctor services, outpatient therapy, and durable medical equipment.
[2] Medicare does not pay for dental care or oral surgery costs unless required as an inpatient for another medical condition (e.g., cancer treatment).
[3] Medicare does not cover vision care. [2] (eye exams, eye glasses, contact lenses, etc.) except as required as an inpatient (e.g., cataract surgery).
[4] Medicare covers diagnostic hearing and balance exams but doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids.
[5] Medicare does not pay for your prescription medications, except as used for treatment in an inpatient setting.