Introduction to Medicare
Cost Basics
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.
What is a premium?
A premium is a set amount (often monthly) you must pay for coverage.
Which costs might I share with Medicare or my plan?
Deductible:
This is a set amount that you pay out of pocket for covered services before Medicare, your Medicare Advantage and/or Prescription Drug plan start to pay.
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You Pay First Up to the Limit
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Medicare and/or Your Plan Begins to Pay
Copayment (copay):
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.
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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:
An 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.
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 will pay for your prescription drugs depends on the drug payment stage you’re in:
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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Medicare Supplement insurance plans (Medigap):
Medigap plans help pay for some of the out-of-pocket costs Medicare doesn’t pay. Most Medigap plans don’t have a yearly maximum out-of-pocket limit; two plans currently do. For Plans K and L, after you meet your out -of-pocket yearly limit and your yearly Part B deductible ($183 in 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.
What costs can I expect for 2019?
Depending on which type of coverage you have, your costs may be different.
Original Medicare:
To get an idea of 2019 costs, you can visit Medicare 2019 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 Insurance Company (UnitedHealthcare), you’ll want to check to see which plans are offered in your area.
Medicare Advantage or Medicare Prescription drug plans:
To get an idea of the out-of-pocket costs for each plan offered by UnitedHealthcare Insurance Company (UnitedHealthcare), you’ll want to check to see which plans are offered in your area.
What if I need help paying Medicare costs?
You may be eligible for financial assistance to cover your health care expenses—many people who could 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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Medicare Supplement insurance plans:
Medigap plans help pay for some of the out-of-pocket costs Medicare doesn’t pay. Most Medigap plans don’t have a yearly maximum out-of-pocket limit; two plans currently do.
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