What does Medicare Cost? (2015)
Neither Part A nor Part B pays for all of a covered person’s medical costs. The Medicare program contains premiums, deductibles and co-pays, which the covered individual must pay out-of-pocket. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare. Howver this program has significant income and asset restrictions.
Some people elect to purchase a type of supplemental coverage, called a Medigap plan, to help fill the holes in Original Medicare (Part A and Part B). These Medicare Supplement insurance policies are standardized by CMS, but are sold and administered by private companies. There is currently no CMS approved supplemental coverage available to fill the Donut Hole, a coverage gap built into Medicare’s Part D benefit.
Commom Medicare Out of Pocket Costs for Medicare Beneficiaries
Medicare Part A (Hospital Insurance) Costs
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Part A Monthly Premium - $0.00*
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Part A Deductible - $1,260 deductible per benefit
*Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $426 each month.
Medicare Part B (Medical Insurance) Costs
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Part B Monthly Premium - Standard Premium - $104.90**
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Part B Deductible - $147.00 (2015)
**Most people will pay the standard premium amount. However, if your modified adjusted gross income (MAGI) as reported on your IRS tax return from 2 years previous is above a certain amount, you may pay more. You pay a Part B premium each month. See Chart Below for Adjusted Premiums
What you pay for a Hospital Stay
In 2015, you pay
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$1,260 deductible per benefit period (Was $1,216)
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$0 for the first 60 days of each benefit period
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$315 per day for days 61–90 of each benefit period (was $304)
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$630 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime) was $608
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All Cost for each hospital day over 150 days
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Blood deductible of the ccost of first 3 pints of blood needed per calender year, unless replaced.
What you pay on Medicare for a Skilled Nursing Facility Stay
In 2015, you pay
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$0 for the first 20 days of each benefit period
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$157.50 per day for days 21–100 of each benefit period (was $152)
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All costs for each day after day 100 of the benefit period
If you have higher income, the law requires an adjustment to your monthly Medicare Part B (medical insurance) and Medicare prescription drug coverage premiums. Higher-income beneficiaries pay higher premiums for Part B and prescription drug coverage. This affects less than 5 percent of people with Medicare, so most people don’t pay a higher premium.
This is called the income-related monthly adjustment amount. Here are the current income levels and premiums:
FILE INDIVIDUAL TAX RETURN
$85,000 or less
above $85,000 up to $107,000
above $107,000 up to $160,000
above $160,000 up to $214,000
above $214,000
FILE JOINT TAX RETURN
$170,000 or less
above $170,000 up to $214,000
above $214,000 up to 320,000
above $320,000 up to $428,000
above $428,000
FILE MARRIED & SEPARATE
TAX RETURN
$85,000 or less
N/A
N/A
above $85,000up to $129,000
above $129,000
YOU PAY
(IN 2015)
$104.90
$146.90
$209.80
$272.70
$335.70
If you have questions about your Part B premium, call Social Security at 1‑800‑772‑1213. TTY users should call 1-800-325-0778. If you pay a late enrollment penalty, these amounts may be higher.
Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) Premiums
Medicare Part D Income Related Premium Adjustment
If you don’t sign up for Part D when you’re first eligible, or if you drop Part D and then get it later, you may have to pay a late enrollment penalty for as long as you have Part D. The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. The late enrollment penalty is calculated by multiplying 1% of the national base beneficiary premium ($33.13 in 2015) times the number of full, uncovered months that you were eligible but didn’t join a Medicare prescription drug plan and went without other creditable prescription drug coverage. This final amount is rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.
Part D Monthly Premium
The chart below shows your estimated prescription drug plan monthly premium based on your income. If your income is above a certain limit, (In 2013) you will pay an income-related monthly adjustment amount in addition to your plan premium (In 2015).
FILE INDIVIDUAL TAX RETURN
$85,000 or less
above $85,000 up to $107,000
above $107,000 up to $160,000
above $160,000 up to $214,000
above $214,000
FILE JOINT TAX RETURN
$170,000 or less
above $170,000 up to $214,000
above $214,000 up to 320,000
above $320,000 up to $428,000
above $428,000
FILE MARRIED & SEPARATE
TAX RETURN
$85,000 or less
N/A
N/A
above $85,000up to $129,000
above $129,000
YOU PAY
(IN 2015)
YPP*
$12.30 + YPP
$31.80 + YPP
$51.30 + YPP
$70.80 + YPP
**YPP - Your Plan Premium - This is the premium charged by the plan provider for the plan you choose in which to enroll.
2015 Part D National Base Beneficiary Premium—$33.13
This figure is used to estimate the Part D late enrollment penalty and the income-relatedmonthly adjustment amounts listed in the table above. The national base beneficiary premium amount can change each year. See your Medicare & You handbook or visit Medicare.gov for more information.
For more information about Medicare costs, visit Medicare.gov.
References:
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Mark Merlis, “The Value of Extra Benefits Offered by Medicare Advantage Plans in 2006,” The Kaiser Family Foundation, January 2008
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Lauren A. McCormick, Russel T. Burge. Diffusion of Medicare’s RBRVS and related physician payment policies – resource-based relative value scale – Medicare Payment Systems: Moving Toward the Future Health Care Financing Review. Winter, 1994.
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CMS – 2015 Medicare Amounts Brochure