Part A (Hospital Insurance)
Medicare Premiums Beneficiary Pays for Part A Monthly Premium
Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
- $506/month for those with fewer than 30 quarters of Medicare-covered employment
- $278/month for those with 30-39 quarters of Medicare-covered employment
Beneficiary Pays for Skilled Nursing Facility Stay
- $0 for the first 20 days of each benefit period
- $200.00 per day for days 21–100 of each benefit period
- All costs for each day after day 100 of the benefit period
Beneficiary Pays for Hospital Stay
- $1,600 deductible per benefit period
- $0 for the first 60 days of each benefit period
- $400 per day for days 61–90 of each benefit period
- $800 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
Part B (Medical Insurance)
Medicare Premiums Beneficiary Pays for Part B Monthly Premium
Most people pay the standard Part B premium amount which is $164.90 in 2023
- If your income was more than $91,000 ($182,000 filing joint) you’ll pay $230.80
- If your income was more than $114,000 ($228,000 filing joint) you’ll pay $329.70
- If your income was more than $142,000 ($284,000 filing joint) you’ll pay $428.60
- If your income was more than $170,000 ($340,000 filing joint) you’ll pay $527.50
- If your income was more than $500,000 ($750,000 filing joint) you’ll pay $560.50
Beneficiary Pays for Part B Services
- $226.00 deductible per benefit period
- 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 a hospital inpatient), outpatient therapy, outpatient mental health services, certain home health services, and durable medical equipment
Medicare Part C (Advantage Plans)
Medicare Advantage plans combine Part A and B into one plan and are offered by Medicare-approved health insurance companies as an alternative option to your Original Medicare coverage. Premiums and out-of-pocket costs may vary depending on your plan, however some premiums can be as low as $0, in addition to your monthly Medicare Part B premium (see above). To ensure you find a plan that fits your specific healthcare needs and budget, please contact our licensed Medicare agent for professional assistance.
Part D (Prescription Drug) Costs
For 2023 Medicare Part D Costs, most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (Part C) or Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.
- If your income was more than $91,000 ($182,000 filing joint) you’ll pay $12.20 + your plan premium
- If your income was more than $114,000 ($228,000 filing joint) you’ll pay $31.50 + your plan premium
- If your income was more than $142,000 ($284,000 filing joint) you’ll pay $50.70 + your plan premium
- If your income was more than $170,000 ($340,000 filing joint) you’ll pay $70.00 + your plan premium
- If your income was more than $500,000 ($750,000 filing joint) you’ll pay $76.40 + your plan premium
Deductibles vary between Medicare drug plans. Some Medicare drug plans don’t have a deductible.
-No Medicare drug plan may have a deductible more than $505 in 2023.
Once your deductible is met, you’ll pay a coinsurance (copay) for prescription drugs. Note that the amount of your copay may change during the benefit period, if the drug price fluctuates.
-Initial coverage limit is $4,660 (plan pays 75% – you pay 25%)
-Once you and your plan pay this amount, you’ll continue to pay 25% of the cost of your prescriptions drugs until you reach your threshold
-Annual out-of-pocked threshold is $7,400
Once you and your plan have spent $4,660 covered drugs in 2023, you’re in the coverage gap (a temporary limit on what the plan covers). Even though you’ll only pay 25% for both brand name and generic drugs at this point, almost the full price of the drug (except for what the plan pays) will count as out-of-pocket costs to help you get out of the coverage gap.
-The manufacturer pays 70% of drug costs
-The plan pays 5% of drug costs
-You pay 25% of drug costs
-The plan also pays 75% of a dispensing fee, you pay 25% of the dispensing fee
Once you reach your threshold ($7,400), you are out of the coverage gap (donut hole) and you’ll automatically get catastrophic coverage. This assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
-You’ll pay 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year.
-Your plan pays the rest
Beginning Jan. 1, 2023, all Medicare Part D and Medicare Advantage plans with prescription coverage will cap the cost of select insulin products at $35.
With this change, you’ll pay no more than $35 for a month’s supply of insulin.
Starting on July 1, people on Original Medicare who use an insulin pump will also pay no more than $35 for a month’s supply of insulin.
Starting in 2023, vaccines covered under Medicare Part D will be free.
This means you pay no deductible, coinsurance or copay for vaccines — even the shingles vaccine — covered by Medicare Part D.
The above premiums represent national averages. Plan premiums can and do vary by state and by carrier.
The above information on Medicare costs was retrieved from Medicare.gov.
Meet Your Medicare Insurance Advisor
Tom Woodward of Westwood Agency and his knowledgeable staff advise and guide individuals through the process of transitioning to Medicare.
With decades of experience, Tom and each insurance professional at Westwood Agency is properly trained on Medicare rules and regulations, and they continually update themselves on the constant changes within the Medicare system. They can help you transition smoothly into the right Medicare coverage that fully serves your healthcare needs, while protecting your life’s savings.