“Out-of-pocket” medical expenses refer to any costs you have to pay yourself. Medicare doesn’t pay for all of your health-care expenses; you’re still responsible for certain costs that Medicare doesn’t cover. This may include:
- Monthly premiums
- Copayments and/or coinsurance
- Excess charge (no more than 15% above the Medicare-approved amount for the service) if you use a provider that doesn’t accept Medicare assignment, meaning the provider doesn’t accept the cost set by the Medicare program as full payment for the service.
- Pharmacy dispensing fee (if you’re enrolled in a Medicare Prescription Drug Plan)
Part A (Hospital)
Most people do not pay a Part A monthly Premium
Out of Pocket Expenses or cost sharing
Days 1-60: $1,316 deductible - one time
Days 61-90: $329 per day
Days 91 and beyond: $658 per day. These are your "lifetime reserve days" you have 60 days total over your lifetime. Once you use these days, they are gone.
Beyond lifetime reserve days: All costs.
Part B (Medical)
The standard Part B premium amount is $134 (If new to Medicare in 2017 or not collecting your social security benefit, or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average).
Deductible and coinsurance
$183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're at the hospital - inpatient), outpatient therapy, and durable medical equipment.
-Example: if you have a $200 bill from the doctor you will pay $40. If you have a $3,000 bill from the doctor you will pay $600.
Part C (Advantage Plans)
The monthly premium amount varies by plan. MAPD Plans are usually the most cost effective option for those on Medicare.
These plans have a Summary of Benefits, which will outline your copay’s and co-insurance.
Part D premium
The monthly premium about varies by plan. The average cost per month is $30 plus drug co-pays or coinsurance
You will have drug Copay so that are broken down by tiers
If you have questions or are confused about which company is best for you, book a meeting with an agent. The goal is to lower your potential cost as low as possible while still receiving great medical care when you need it.
Please share us with your friends, family or neighbors. A referral is the greatest complement we can receive.