2019 Medicare Prices and Out-of-Pocket Costs
Last Updated : 10/31/20194 min read
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 2019.
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 $437 per month in 2019.
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 $1,364 for each benefit period.
- Coinsurance per benefit period for hospitalization:
- For days 1 to 60: No coinsurance payment
- For days 61 to 90: $341 coinsurance per day
- For days 91 and beyond: $682 coinsurance per each “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 $170.50 in 2019 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.
In 2019, the standard Part B monthly premium is $135.50.
If the modified adjusted gross income reported on your individual IRS tax return two years ago is above $85,000, you may pay a higher premium.
Beneficiaries pay $185 per year for their Medicare Part B deductible in 2019. 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.
The average monthly premium for Medicare Advantage plans decreased from $12 to $8 between Q1 2018 and Q1 2019 according to an eHealth research report.
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 2019 may vary by plan.
The average monthly premium for Part D prescription drug plans decreased 4 percent, from $26 to $25 in 2019 according to an eHealth research report.
Medicare Supplement plans, or Medigap
The ten 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. The plans are named by letter, such as Plan A or N. 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 ten 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.
According to eHealth research, Medicare Supplement premiums increased for 2019. Medicare Supplement plans were the only product that showed an increase in average premiums between the 2018 and 2019 AEPs (from $141 to $152 per month).
To begin looking for Medicare plans in your area, enter your ZIP code on this page.