2018 Medicare Prices and Out-of-Pocket Costs

Steven Mott by Steven Mott | Licensed since 2012

This article was updated on: 07/05/2018

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Your out-of-pocket Medicare costs may change from one year to the next. Stay up to date on Medicare premiums, deductibles, copayments, and coinsurance costs in 2018.

Medicare Part A, hospital coverage

Medicare Part A helps cover inpatient hospital care, inpatient care in a skilled-nursing facility care (not custodial or long-term care), inpatient care in a religious nonmedical health care institution, hospice and some home health-care services.

Most people qualify for premium-free Medicare Part A. If you or your spouse did not work for at least 10 years while paying Medicare taxes, then you could have to pay a premium of up to $422 per month in 2018.

If you are hospitalized, your Medicare Part A coverage and out-of-pocket expenses for each benefit period are as follows (assuming your hospitalization meets Medicare requirements):

  • Deductible: You pay a deductible of $1,340 for each benefit period.
  • Coinsurance per benefit period for hospitalization:
    • For days 1 to 60: No coinsurance payment
    • For days 61 to 90: $335 coinsurance per day
    • For days 91 and beyond: $670 coinsurance per “lifetime reserve day*”
    • After a 90-day hospitalization in one benefit period, each additional day counts toward your lifetime reserve of 60 days of hospitalization covered by Medicare Part A.
    • For days beyond your lifetime reserve days: You pay all costs.

If you receive care in a skilled-nursing facility, you pay a daily coinsurance of $167.50 for days 21 through 100 in a benefit period. Medicare Part A typically doesn’t cover your costs for days 101 and beyond.

*Medicare may give you up to 60 lifetime reserve days, where Medicare pays for covered services and you pay a daily coinsurance, after you’ve been in a hospital longer than 90 days within a single benefit period.

Medicare Part B, medical coverage

Medicare Part B generally helps cover medical routine health services, such as doctor office visits, lab work, and radiology.

The amount you pay for your Medicare Part B premium may vary depending on your situation:

  • Most beneficiaries who get Social Security benefits pay a lower premium than the standard premium described below. If you pay your Part B premium through your monthly Social Security benefit, the average premium is $130.
  • The standard Part B monthly premium is $134.00 in 2018, which most people pay if any of the following applies:
    • You enrolled in Part B for the first time in 2018.
    • You don’t receive Social Security or Railroad Retirement Board benefits yet.
    • You have both Medicare and Medicaid coverage (you’re a dual eligible), and Medicaid pays for your monthly premiums. If you qualify, your $134 premium is paid by the Medicaid program.
    • You’re directly billed for your Part B premium.

In addition, you may pay a higher premium if the modified adjusted gross income reported on your individual IRS tax return two years ago is above $85,000.

Beneficiaries pay $183 per year for their Medicare Part B deductible in 2018.  After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment.

Medicare Part C, Medicare Advantage

Medicare Advantage plans and Medicare Advantage Prescription Drug plans available in your state and zip code are offered by private insurance companies approved by Medicare. Therefore, your premiums, deductibles, copayments, and coinsurance all depend on the particular plan you select.

Do note that some Medicare Advantage plans may offer $0 premiums; however, you still have to pay your Medicare Part B premium when you’re enrolled in any Medicare Advantage program, along with any premium the plan may charge.

Medicare Part D, stand-alone Prescription Drug Plans

Similarly, the stand-alone Prescription Drug Plans that make up Medicare Part D are offered by Medicare-approved private insurance companies operating in your state and zip code. So, your total premiums and out-of-pocket costs in 2018 may vary by plan.

Medicare Supplement plans, or Medigap

The 10 standardized Medicare Supplement plan types offered in most of the 50 states can cover some of the out-of-pocket expenses you can incur if you have Original Medicare, Part A and Part B. (Forty-seven states offer the 10 Medigap plan types, named by letter, such as Plan F. The Medigap plans for Massachusetts, Minnesota, and Wisconsin residents vary a bit from those offered in the other states.)

While the coverage offered by each of the 10 lettered Medigap plan types is standardized, the pricing may vary depending on your location and the insurance company you select. Medigap policy costs may also vary based on inflation and other factors, such as medical underwriting.

Beyond that, Medicare Supplement policies are priced on a few different models:

  • Community-rated pricing: The premium is the same for every beneficiary who holds the policy.
  • Issue-age-rated pricing: The premium is based on your age at the time you first enroll in the policy.
  • Attained-age-rated pricing: The premium is based on your current age every policy period.

Of course, what I’ve given you here are general guidelines for Medicare costs in 2018. To find out which Medicare plan options are actually available in your area, and their costs, you have a few options:

  • Set up an appointment to talk with me about your Medicare needs. Or, if you like, I can email you Medicare plan options; you can find both of those links below.
  • If you’d like to compare Medicare plans on your own, use the Compare Plans buttons on this page.
  • For immediate help by phone, just contact us. Our information is below.

Medicare has neither reviewed nor endorsed this information.

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