Will My Medicare Premium Rise If I Get Sick?

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 08/23/2018

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Your monthly premium for Original Medicare (Part A and Part B) is set each year by the Center for Medicare and Medicaid Services (CMS). Original Medicare premiums are standardized, and the amount you pay depends on several factors including your income, but they generally cannot be raised due to your health status or whether you get sick. However, your Part B premium can go up if your income rises above a certain level. Here’s what you should know about your premiums and when you might expect a Medicare premium increase.

How are Medicare premiums calculated?

Most people qualify for premium-free Part A, but if you or your spouse haven’t worked at least 10 years while paying Medicare taxes, you generally need to pay a monthly premium. The premium may increase year to year, but has nothing to do with your health status.

You’ll typically pay a Part B premium. The standard Part B premium is set by CMS ($134 per month in 2018). There is a premium adjustment for people with higher incomes and some beneficiaries will pay higher Medicare premiums based on their income. On the other hand, if you have a low income, it may be possible to get help paying your Part B premium. According to CMS, most people who receive Social Security will pay slightly less than the standard premium each month for their Part B coverage. Read more about the Part B premium.

CMS reviews premiums each year and from time to time, they may increase Medicare premiums to help balance the costs of the program. These premium increases typically affect all enrollees and are not tied to the health conditions of an individual enrollee.

If you do not qualify for premium-free Part A because you or your spouse do not have 10 years of qualifying work history under Medicare rules, you can usually still purchase Medicare coverage. The Medicare premiums for Part A are $422 per month in 2018 for less than 71/2 years of qualifying work history and $232 for 71/2 to up to 10 years of qualifying work history.

Will my Medicare premiums increase if I have Medicare Advantage and get sick?

Medicare Advantage (Medicare Part C) is an alternative way to get your Original Medicare benefits. These plans are offered by private insurance companies approved by Medicare and they are free to set their own premiums. Medicare Advantage must cover, at a minimum, everything that Original Medicare covers, except for hospice care, which is still covered under Part A. Many Medicare Advantage plans offer extra benefits to their members such as Part D coverage for prescription drugs and coverage for routine dental and routine vision care.

If you enroll in a Medicare Advantage plan, you must still pay your Part B premium plus any premium required by your plan. However, premiums under Medicare Advantage generally must be the same for everyone enrolled in a particular plan offered by a particular company. These plans generally cannot generally raise your Medicare based on your health status, meaning that if you get sick, your plan cannot raise your monthly premiums.

Keep in mind that not all plan types and options may be available in all locations and your premium may vary depending on where you live and the type of plan you select.

Can my Medicare Supplement insurance plan raise my premiums if I get sick?

Medicare Supplement insurance plans, also known as Medigap, are priced a bit differently than Original Medicare and Medicare Advantage plans. Medigap plans are offered by private companies and may help pay your out-of-pocket costs under Original Medicare. These plans are priced in one of three ways:

  • Community-rated, where everyone who buys a particular plan pays the same premium regardless of age.
  • Issue-age rated, where premiums are calculated based on the age you are when you enroll in a plan.
  • Attained-age rated, where premiums gradually increase over time as you reach a certain age.

If you decide you want a Medigap plan, it’s important to enroll during your Medicare Supplement Open Enrollment Period, which is generally the six-month period that starts the month that you’re both 65 years old (or older) and enrolled in Medicare  Part B. You usually cannot be turned down during this period, even if you get sick or have a pre-existing condition, and your premiums will be the same as someone with no health issues. You might face a waiting period for health services related to your medical condition.

However, if you do not enroll during this period and decide later that you want a Medicare Supplement plan, or if you decide to switch to a different Medigap plan, you may have to pay a higher premium based on your health status. Companies that offer Medicare Supplement plans may use medical underwriting to set their premiums, so if you get sick and then apply for coverage outside your Medicare Supplement Open Enrollment Period, you may not be accepted or your premiums may be higher.

Have more questions about Medicare premiums, Medicare Advantage, or Medigap? I am happy to give you more information and answer your questions. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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