Medicare Part B Costs


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What is the cost of Medicare Part B?

Your share of Medicare Part B costs includes a monthly premium, an annual deductible and co-insurance for most services. Medicare sets the amount for each of these every year. 

Medicare also decides how much it is willing to pay for specific medical services and procedures. The amount Part B will pay is called the Medicare-approved amount    . Your Part B co-insurance is based on the Medicare-approved amount.

There are no limits on your out-of-pocket spending with Part B. Your expenses could be substantial if you have a chronic condition or serious illness.

2015 Part B Costs

Premium

  • $104.90 up to $335.70 per month depending on your income and tax filing status

Deductible

  • $147 per year

Co-payment

  • None

Co-insurance

  • 20% of the Medicare-approved amount for most covered services
  • 20% of the Medicare-approved amount for durable medical equipment, such as a walker or wheelchair
  • 35% of the Medicare-approved amount for most outpatient mental health care

STORY SUMMARIES

Ellen’s story: Doctor accepts Medicare assignment

Roger’s story: Doctor does not accept Medicare assignment

Ellen

Ellen visited a doctor who accepts Medicare assignment. She has already paid her deductible for the year.


  • Interpret cardiovascular stress test $175
  • Read diagnostic X-ray$125
  • Doctor's usual and customary fee$300
  • Total Medicare-approved amount$220
  • Medicare pays 80% of approved amount$176
  • Ellen’s 20% of approved amount$44

Total Ellen pays $44

The costs shown are for illustration only. Your actual costs may be different.

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Roger

 

Roger visited a doctor who doesn’t accept Medicare assignment. Roger has already satisfied his deductible.

 

  • Interpret cardiovascular stress test $175
  • Read diagnostic X-ray$125
  • Doctor’s usual and customary fee$300
  • Total Medicare-approved amount$220
  • Reduced Medicare-approved amount
    (95% of Medicare-approved amount) $209
  • Medicare-approved amount
    + 15% of approved amount$240
  • Medicare pays 80% of approved amount$176
  • Roger's 20% co-insurance$42
  • Roger's 15% "excess charge"    $31

Total Roger pays $73

(co-insurance + excess charge)

The costs shown are for illustration only. Your actual costs may be different.

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Even though Roger’s doctor doesn’t accept Medicare assignment in this case, Medicare still limits the excess charges he must pay to 15% of the Medicare-approved amount. The doctor receives $240. This is less than the usual and customary fees of $300 but more than the Medicare-approved amount.

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