The Different Parts of Medicare in 2018
This article was updated on: 10/20/2018
There are several “parts” to Medicare, as you may know. Costs and benefit details may change from one year to the next. Here’s a quick summary of out-of-pocket Medicare costs in 2018.
2018 Medicare Part A costs
Medicare Part A helps cover inpatient hospital expenses. As a Medicare beneficiary, you’re generally eligible for premium-free Medicare Part A coverage if you or your spouse paid Medicare taxes while working for 10 years or more. However, beneficiaries who do need to pay for Part A coverage in 2018 pay a premium up to $422 per month.
The Medicare Part A deductible for 2018 is $1,340 for each benefit period. A deductible is the amount you, the beneficiary, must pay out of pocket before Medicare begins covering its share of covered services.
Further, the 2018 coinsurance for hospital inpatient stays for each benefit period is as follows:
- No coinsurance for covered hospital stays 60 days or less.
- A daily $335 coinsurance for days 61 through 90 of a covered stay.
- A daily $670 coinsurance for days 91 and beyond (days 91 and beyond in each benefit period are considered part of your “lifetime reserve days”; you can have up to 60 of these days over your lifetime).
- After lifetime reserve days are used up, you pay all costs (unless you have separate insurance coverage outside of Medicare Part A that covers these costs).
The 2018 coinsurance for skilled nursing facility stays for each benefit period is the following:
- No coinsurance for 20 days or less
- A daily $167.50 coinsurance for days 21 through 100
- You are responsible for all costs for days 101 and beyond
2018 Medicare Part B costs
Medicare Part B, medical insurance, helps cover services and supplies including, but not limited to, doctor visits, lab tests, and wheelchairs.
Your Medicare Part B premium amount may vary depending on your situation. There are a few different scenarios:
- You’ll generally pay a lower amount than the Part B standard monthly premium for 2018 unless one of the conditions below fits your situation.
- You’ll generally pay the Part B standard monthly premium of $134.00 if any of the following applies to you:
- You enrolled in Part B for the first time in 2018.
- You aren’t receiving Social Security or Railroad Retirement Board benefits.
- You’re a dual eligible (meaning you get both Medicare and Medicaid benefits), and Medicaid pays for your premiums. If you qualify, your $134 premium is paid by the Medicaid program.
- You’re billed directly for your Part B premium.
Your Part B premium could be higher if your income is above a certain amount. Beneficiaries with higher modified adjusted gross incomes, as reported on their IRS tax return from two years ago, may have to pay a higher premium. See this article on Medicare premiums and deductibles for more information.
The 2018 annual deductible for Medicare Part B services is $183 per year. You’re typically also responsible for 20% of the Medicare-approved amount for most medical services, assuming that the doctor or other health-care provider accepts Medicare assignment (Medicare-approved amount as full payment). Medicare Part B provides many preventive services at no cost to you; these services are available without requiring you to meet your deductible. There may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.
2018 Medicare Advantage (Part C) costs
The Medicare Advantage program, also known as Medicare Part C, provides a way to receive your Original Medicare (Part A and Part B) benefits, except for hospice care, which Part A covers. Medicare Advantage plans are offered by private health insurance companies approved by the Medicare program, and sometimes include additional benefits such as routine vision care. While these insurance companies must follow government regulations, they have some flexibility in setting certain costs and/or additional coverage rules, as well as what additional benefits they may provide with their coverage. This means that the availability, benefits, costs, and other details of these plans can change from year to year.
In regards to 2018 costs, your out-of-pocket expenses depend on the Medicare Advantage plan you’re enrolled in.
2018 Medicare Part D costs
Medicare Part D Prescription Drug Plans are similar to Medicare Advantage plans in that these plans are also offered by Medicare-approved private insurance companies. Medicare Part D prescription drug plan availability, costs, benefits, and other details also vary by plan and may change each year.
While insurance companies set most of their Medicare Part D costs, there are certain predetermined limits set by the government on an annual basis. In 2018, no Part D Prescription Drug Plan can have an annual deductible higher than $405.
There are also limits related to the Medicare coverage gap, also known as the “donut hole.” Not everyone will reach this gap. Beneficiaries will hit this Medicare Part D coverage gap in 2018 when they and their plan have spent a total of $3,750 on covered prescription drugs, which includes the annual deductible (if your plan has one). Once beneficiaries have entered the coverage gap in 2018, they will generally pay no more than 35% of their plan’s cost for brand-name drugs and 44% of their plan’s cost for generic drugs. Beneficiaries will exit the coverage gap and enter the catastrophic coverage phase when they reach a total of $5,000 on eligible prescription drug costs for the year. After you have reached the catastrophic period, you’ll pay a small copayment or coinsurance amount for covered prescription drugs.
There are many Medicare plan options in 2018, and I can tell you more about the plans eHealth offers.
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