Introduction to Medicare
Medicare Cost Basics
It’s important to pay attention to more than just monthly Medicare premiums. What you 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.
Deductible:
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.
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You Pay First Up to the Limit
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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):
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 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?
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.
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):
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]]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 ($185 in 2019), the Medigap plan pays 100% of covered services for the rest of the calendar year.
Note: In Massachusetts, Minnesota and Wisconsin, there are different plan options available. [[state-end]]
[[state-start:FL]]Two Medicare supplement plans currently do have an out-of-pocket spending limit. For Medicare supplement plans K and L, once the annual out-of-pocket maximum amount and Part B deductible is met, these plans pay 100% of the Medicare co-payment and coinsurance for the rest of the calendar year. Costs that do not apply to the annual out-of-pocket maximum include premiums, charges from your provider that exceed Medicare-approved amounts (called "Excess Charges") and services not covered by Original Medicare. [[state-end]]
What costs can I expect for 2020?
Depending on which type of coverage you have, your costs may be different.
Original Medicare:
To get an idea of 2020 costs, you can visit Medicare 2020 costs at a glance on the Medicare.gov website.
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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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Medicare Advantage 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 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.
Get more information about PACE
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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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UnitedHealthcare and AARP Medicare Plans
See all of the Medicare Advantage, Medicare prescription drug, and Medicare Supplement plans where you live.
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]]Give Us a Call
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.
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Make an appointment for Medicare Supplement Insurance Plans
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Meet with a Licensed Insurance Agent/Producer
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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. 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.
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).
You must be an AARP member to enroll in an AARP Medicare Supplement Plan.
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.
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.