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Introduction to Medicare
Cost Basics
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Introduction to Medicare
Medicare Cost Basics
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[[state-start:OR,VI]] Medicare isn't free. And it's important to pay attention to more than just monthly premiums. The amount you'll pay depends on the coverage you choose and the health care services you receive. And don't forget to see if you may qualify for help with your Medicare costs.
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[[state-start:null,AL,AK,AR,AZ,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,NY,OH,OK,PR,RI,SC,SD,TN,TX,UT,VT,VA,WA,DC,WV,WI,WY]]Medicare isn't free. It's important to pay attention to more than just monthly premiums. The amount you pay depends on the coverage you choose and the health care services you receive. And don't forget to see if you qualify for help with your Medicare costs.
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[[state-start:PA]] It's important to pay attention to more than just monthly Medicare premiums. What you'll pay depends on your coverage and the health care services you receive. Don’t forget to see if you qualify for help with your Medicare costs, too.
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What is a premium?
A premium is a set amount (often monthly) you must pay for coverage. [[state-start:null,AL,AK,AR,AZ,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,`NY,OH,OK,PR,RI,SC,SD,TN,TX,UT,VT,VA,WA,DC,WV,WI,WY]]Depending on which type of coverage you choose, you may pay a premium to Medicare, to a private insurance company like UnitedHealthcare, or both.[[state-end]]
[[state-start:OR,VI]]Which costs might I share with Medicare or my plan?[[state-end]]
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Which costs might I share with Original Medicare or my plan?
"Cost sharing" is a term used to describe the way Original Medicare or your plan shares your health care costs with you. Here are the most common types of cost sharing:
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Deductible:
[[state-start:null,AL,AK,AR,AZ,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,NT,OH,OK,PR,RI,SC,SD,TN,TX,UT,VT,VA,WA,DC,WV,WI,WY]]This is a set amount that you pay out-of-pocket for covered services before Medicare, your Medicare Advantage plan, and/or your Prescription Drug plan start to pay. If you have a Medicare Supplement insurance plan, this is the amount your plan may help pay after Medicare pays, depending on the plan you choose. [[state-end]]
[[state-start:PA]]This is a set amount that you pay out of pocket for covered services before Medicare, your Medicare Advantage plan, and/or your Prescription Drug plan start to pay. [[state-end]]
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You pay first, up to the deductible
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Medicare and/or your plan begins to pay
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Depending on the Medicare Supplement insurance plan chosen, this is the amount your plan may help pay after Medicare pays.
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Copayment (copay):
[[state-start:OR,PA,VI]]A fixed amount that you pay each time you receive a covered service. For example, if you have prescription drug coverage, you might pay $10 each time you fill a certain prescription. [[state-end]]
[[state-start:null,AL,AK,AR,AZ,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,NY,OH,OK,PR,RI,SC,SD,TN,TX,UT,VT,VA,WA,DC,WV,WI,WY]]An amount you may be required to pay as your share for the cost of a covered service. For example, if you have prescription coverage, you might pay $10 each time you fill a certain prescription. If you have a Medicare Supplement plan, copayments paid by the plan are either paid in full or a percentage of the copayment is paid, depending on the plan you choose. [[state-end]]
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You pay a fixed amount
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Medicare Advantage or Prescription Drug plans: They will be billed for the rest
Coinsurance:
[[state-start:OR,PA,VI]]An amount you pay as your share for the cost of a covered service. For example, Medicare Part B pays about 80% of the cost of a covered medical service and you would pay the rest. [[state-end]]
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The amount you may be required to pay as your share for the cost of a covered service. For example, Medicare Part B pays about 80% of the cost of a covered medical service and you would pay the rest.
There are Medicare Supplement Insurance Plans with low to no coinsurance options. Depending on the plan you choose, you may get help paying the Part A and/or Part B coinsurance amounts.
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Medicare Costs You Could Pay
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Are there plans that limit out of pocket spending each year?
It depends on which type of coverage you have.
Original Medicare (Parts A and B):
No.
Medicare Advantage (Part C) plans:
Yes. After you reach the annual out-of-pocket maximum, your plan will pay all your costs for Medicare-covered services for the rest of the period (usually a calendar year). Costs that do not apply to the annual out-of-pocket maximum include premiums, Part D prescription drugs, and extra benefits that are not covered by Original Medicare.
Medicare Prescription Drug (Part D) plans:
No. But the amount you pay for your prescription drugs depends on the drug payment stage you’re in:
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Are there plans that limit out-of-pocket spending each year?
An out-of-pocket limit is also known as an out-of-pocket maximum. Whether or not there is a limit depends on which type of plan you have.
Original Medicare (Parts A and B):
No. Original Medicare doesn't have an out-of-pocket maximum.
Medicare Advantage (Part C) plans:
Yes. Medicare Advantage plans have a limit to how much you'll pay out-of-pocket every year. After you reach the annual out-of-pocket maximum, your plan pays all costs for Medicare-covered services for the rest of the period (usually a calendar year). There are some costs that don't count toward your annual out-of-pocket maximum, such as premiums, Part D prescription drugs, and extra benefits that aren't covered by Original Medicare.
Medicare Prescription Drug (Part D) plans:
No. Part D plans don't have an out-of-pocket maximum. The amount you pay for your prescription drugs depends on the drug payment stage you're in.
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Are there costs I'll have to pay out of my own pocket? And are there plans that limit out-of-pocket spending each year?
The out-of-pocket maximum is the maximum amount you will pay out-of-pocket in a plan year before your Medicare plan begins to cover 100% of the costs associated with your medical services. Original Medicare does not have an out-of-pocket maximum.
The costs you might have to pay out of your own pocket depend on the type of coverage you have. Some plans, like Medicare Supplement plans, help to limit those out-of-pocket costs.
Original Medicare (Parts A and B):
Original Medicare has no annual out-of-pocket maximum. You might be responsible for the following costs with Original Medicare:
- Part A premium
- Part A deductible ($1,484 in 2021) and coinsurance
- Part B premium
- Part B deductible ($203 in 2021) plus the coinsurance after the Part B deductible is met and Medicare has paid its share
Medicare Advantage (Part C) plans:
Medicare Advantage plans limit how much you'll pay out of pocket every year. After you reach the annual out-of-pocket maximum, your plan will pay all of your costs for Medicare-covered services for the rest of the period (usually a calendar year). Costs that don't apply to your annual out-of-pocket maximum include premiums, Part D prescription drugs, and extra benefits your plan might have that aren't covered by Original Medicare.
Learn more about Medicare Advantage Plan costs
Medicare Supplement insurance plans (Medigap):
Medicare supplement plans are designed to help limit out-of-pocket costs by helping to pay for some of the costs Original Medicare doesn't pay. There are Medigap plan options available with low to no copays. For example, the only out-of-pocket costs associated with Plan G would be your monthly premium and the annual Part B deductible ($203 in 2021). Medigap plans offer peace of mind with predictable out-of-pocket costs. Benefits and costs vary depending on the plan you choose.
Two Medigap plans do have a yearly out-of-pocket limit. These plans, Plans K and L, offer a lower monthly premium than other Medicare supplement plans because they pay a percentage of the coinsurance and you pay the rest. Once you meet the annual out-of-pocket limit, the plans pay 100% of covered services for the rest of the calendar year. Please note that the benefits, if covered, are covered 100% by most plans.
Learn more about Medicare Supplement insurance plan costs
Medicare Prescription Drug (Part D) plans:
Part D plans don't have an out-of-pocket maximum. But the amount you'll pay for your prescription drugs depends on the drug payment stage you're in.
[[state-end]]Drug Payment Stages:
| Stage 1: Annual Deductible |
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| Stage 2: Initial Coverage |
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| Stage 3: Coverage Gap (also called “Donut Hole”) |
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| Stage 4: Catastrophic Coverage |
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Drug Payment Stages:
| Stage 1: Annual Deductible |
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| Stage 2: Initial Coverage |
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| Stage 3: Coverage Gap (also called "Donut Hole") |
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| Stage 4: Catastrophic Coverage |
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Drug Payment Stages:
| Stage 1: Annual Deductible |
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| Stage 2: Initial Coverage |
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| Stage 3: Coverage Gap (also called “Donut Hole”) |
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| Stage 4: Catastrophic Coverage |
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What costs can I expect for 2021?
Depending on which type of coverage you have, your costs may be different.
Original Medicare:
To get an idea of 2021 costs, you can visit Medicare costs at a glance on the Medicare.gov website.
Medicare Advantage, Medicare Supplement insurance or Medicare Prescription drug plans:
To get an idea of the out-of-pocket costs for each plan offered by UnitedHealthcare, you'll want to check to see which plans are offered in your area.
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What costs can I expect for 2021?
Depending on which type of coverage you have, your costs may be different.
Original Medicare:
To get an idea of 2021 costs, you can visit Medicare costs at a glance on the Medicare.gov website.
Medicare Advantage, Medicare Supplement insurance or Medicare Prescription drug plans:
It's easy to find the out-of-pocket costs for each plan offered by UnitedHealthcare. Use the link below to find plans where you live.
Not all plans are available in all areas.
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What are Original Medicare (Parts A and B) costs?
Medicare Part A Costs
Premium:
Most people don't pay a premium for Medicare Part A. You won't pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years.
Deductible:
You're required to pay a deductible before Medicare Part A starts paying part of your costs.
Coinsurance:
For inpatient hospital and skilled nursing facility stays, you are responsible for any coinsurance after Medicare has paid its share.
Medicare Part B Costs
Premium:
Your monthly premium for Medicare Part B depends on your monthly income.
Deductible:
You're required to pay a deductible before Medicare Part B starts paying part of your costs.
Coinsurance:
Once your deductible is met, Part B generally pays 80% of Medicare-approved costs and you're responsible for the rest.
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What if I need help paying Medicare costs?
You may be eligible for financial assistance to cover your health care expenses—many people who qualify never sign up. So don’t hesitate to apply. Income and resource limits vary by program.
Medicaid:
Provides health care coverage for people and families with limited incomes. It may also include some services not covered by Medicare, like prescription drugs, eye care or long-term care.
Medicare Savings Programs:
Help pay Original Medicare (Parts A and B) premiums, deductibles, and coinsurance. You automatically qualify for the Extra Help program (see below) if you qualify for a Medicare Savings Program.
Programs of All-Inclusive Care for the Elderly (PACE):
Combine medical, social and long-term care services for people over the age of 55 who qualify. This program is not available in all states.
Extra Help program:
Helps pay some or all Medicare Part D premiums, deductibles, copays and coinsurance for those who qualify.
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What if I need help paying Medicare costs?
There are several programs that help pay Medicare costs. Unfortunately, many people who qualify never sign up. Don’t hesitate to apply. Income and resource limits vary by program.
Extra Help program:
Helps pay some or all Medicare Part D premiums, deductibles, copays and coinsurance for those who qualify.
Get help with prescription drug costs
Medicaid:
Provides health care coverage for individuals and families with limited incomes. It may also include some services not covered by Medicare, like prescription drugs, eye care or long-term care.
Medicare Savings Programs:
Helps pay Original Medicare (Parts A and B) premiums, deductibles, and coinsurance. You automatically qualify for the Extra Help program if you qualify for a Medicare Savings Program.
Find out if you qualify for Medicare Savings Programs
Programs of All-Inclusive Care for the Elderly (PACE):
Combines medical, social and long-term care services for people over the age of 55 who qualify. This program is not available in all states.
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What if I need help paying Medicare costs?
You may be eligible for financial assistance to cover your health care expenses. There are several programs that help pay Medicare costs. Many people who could qualify never sign up, so be sure to apply if you think you might qualify. Don't hesitate to apply. Income and resource limits vary by program.
Extra Help program:
Helps pay some or all Medicare Part D premiums, deductibles, copays and coinsurance for those who qualify.
Learn how to get help with prescription drug costs
Medicaid:
Provides health care coverage for individuals and families with limited incomes. It may also include some services not covered by Medicare, like prescription drugs, eye care or long-term care—at no or low cost. If you have both Medicaid and Medicare, you may be eligible for a Dual Special Needs Plan (D-SNP).
Learn more about Medicaid and Dual Eligibility
Medicare Savings Programs:
Help pay Original Medicare (Parts A and B) premiums, deductibles, and coinsurance. You automatically qualify for the Extra Help program (see above) if you qualify for a Medicare Savings Program.
Find out if you qualify for a Medicare Savings Program
Programs of All-Inclusive Care for the Elderly (PACE):
Combine medical, social and long-term care services for people over the age of 55 who qualify. This program is not available in all states.
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[[state-start:OR,VI]]See UnitedHealthcare Plans Available In Your Area
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See UnitedHealthcare Plans Available In Your Area
[[state-end]]UnitedHealthcare and AARP Medicare Plans
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Explore the Medicare Advantage, Medicare Prescription Drug and Medicare Supplement plans that may be available in your area. Or learn if you qualify for a Medicare Special Needs Plan.
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See all of the Medicare Advantage, Medicare Prescription Drug, and Medicare Supplement plans where you live.
[[state-end]]Still have questions?
Give Us a Call
Call UnitedHealthcare: 1-855-264-3796 (TTY 711)
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Hours: 8 a.m. – 8 p.m., 7 days a week.
[[state-end]] [[state-start:AK,HI]]Hours: 8 a.m. – 8 p.m. Monday – Friday, 8 a.m. – 5 p.m. Saturday and Sunday.
[[state-end]]Call UnitedHealthcare: 1-855-265-1557 (TTY 711)
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Hours: 8 a.m. – 8 p.m., 7 days a week.
[[state-end]] [[state-start:AK,HI]]Hours: 8 a.m. – 8 p.m. Monday – Friday, 8 a.m. – 5 p.m. Saturday and Sunday.
[[state-end]]Call UnitedHealthcare: 1-855-264-3796 (TTY 711)
Hours: 7 a.m. – 11 p.m. ET, Monday – Friday, 9 a.m. – 5 p.m. ET, Saturday.
Call UnitedHealthcare: 1-855-264-3796 (TTY 711)
Hours: 7 a.m. – 11 p.m. ET, Monday – Friday, 9 a.m. – 5 p.m. ET, Saturday.
Meet with a Licensed Insurance Agent/Producer
Make an appointment for Medicare Advantage or Part D Prescription Drug Plans - Opens in new window
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Make an appointment for Medicare Supplement Insurance Plans
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Make an appointment for Medicare Advantage or Part D Prescription Drug Plans - Opens in new window
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Make an appointment for Medicare Supplement Insurance Plans
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View Important Disclosures Below
UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.
AARP® encourages you to consider your needs when selecting products and does not make product recommendations for individuals.
Please note that each insurer has sole financial responsibility for its products.
AARP® Medicare Supplement Insurance Plans
AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company.
Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents). Policy form No. GRP 79171 GPS-1 (G-36000-4).
In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
This is a solicitation of insurance. A licensed insurance agent/producer may contact you.
You must be an AARP member to enroll in an AARP Medicare Supplement Plan.
THESE PLANS HAVE ELIGIBILITY REQUIREMENTS, EXCLUSIONS AND LIMITATIONS. FOR COSTS AND COMPLETE DETAILS (INCLUDING OUTLINES OF COVERAGE), CALL A LICENSED INSURANCE AGENT/PRODUCER AT THE TOLL-FREE NUMBER ABOVE.
Medicare Advantage plans and Medicare Prescription Drug plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. You do not need to be an AARP member to enroll in a Medicare Advantage plan or Medicare Prescription Drug plan.
This information is not a complete description of benefits. Contact the plan for more information.