Summary Medicare Coverage and Costs

The landscape covering seniors and community elderly for Medicare benefits can be difficult to navigate. Professional advice – see your local SHINE officer at area Council on Aging – will help simplify the myriad of individualized options.

Medicare will help to cover the majority of your health care expenses each year. But you still may have to pay thousands of dollars in out-of-pocket costs:

Here is a simple breakdown of coverage area and benefits:

  • Medicare Part A: No fee for the majority of beneficiaries
  • Medicare Part B: $135.50 monthly for 2019. This amount is automatically deducted from your Social Security benefit payments. (Individuals with an annual income of more than $85,000 and couples with an annual income of more than $170,000 will pay a higher premium.)
  • Part C (Medicare Advantage): includes $135.50 monthly for the Part B premium (see above) for 2019, plus any additional premium set by the insurer
  • Medicare Part D prescription drug plan: Premium varies by plan. Averages $32.50 monthly for 2019.
  • Medigap: Amount varies by plan and extent of coverage.


Deductibles:

  • Part A: $1,364 for hospital stays
  • Part B: $185 annually
  • (Some Medigap policies cover Part A and B deductibles.)
  • Part C (Medicare Advantage): Amount varies by plan.
  • Part D prescription drug plan: Amount varies by plan but cannot exceed $415 a year.


Co-pays:

  • Part C (Medicare Advantage): Amount varies by plan and by service.
  • Part D prescription drug plan: Amount varies by plan and by prescription.


Co-insurance

  • Part A: No fee for hospital stays of 60 days or less. For 61 to 90 days, $341 per day. For 91 days or more, $682 per day or full cost of stay, depending on usage of “lifetime reserve days.”
  • Part B: Typically, 20 percent of the Medicare-approved cost of the service for most services
  • Medigap policies typically cover Part A and B coinsurance.
  • Part C (Medicare Advantage): Amount varies by plan and by service.

If an elder is finding it difficult to afford Medicare’s out-of-pocket costs — those premiums, deductibles, co-pays and co-insurance can easily result in a large tab each year — you might be eligible for federal and state assistance. These programs are designed for beneficiaries with incomes that are too high to qualify for Medicaid, the federal-state health insurance program for low-income individuals, but who still have trouble paying their health care bills. Each program has specific income and asset limits and eligibility requirements that are adjusted annually.

JD Miller

About JD Miller

John D. Miller is the founder/owner of Home Care Partners, LLC, a Massachusetts business providing private duty, personalized in-home assistance and companion care services to those needing help in daily activities and household functions. Phone: (781) 378-2164 Email: [email protected] Website: https://homecarepartnersma.com
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