3 Costs Medicare Beneficiaries Have to Pay Out of Pocket

3 Costs Medicare Beneficiaries Have to Pay Out of Pocket
November 26 17:00 2017

Are you counting the days until you become eligible for Medicare as you watch health insurance premiums rise and wonder about the future of Obamacare? If so, you’re not alone.

Unfortunately, once you actually claim Medicare benefits, you’ll likely find your insurance situation isn’t any simpler and your costs aren’t much lower — and may even be higher.

Just 43% of middle-income Americans found healthcare expenses on Medicare to be in line with expectations, and middle-income families were three times more likely to pay more than planned, rather than less.

Planning for healthcare costs as a Medicare beneficiary is important for a secure retirement. Here are three key costs to prepare for so you won’t be taken by surprise when you get your Medicare card.

1. Medicare deductibles

Medicare beneficiaries must pay a deductible before they receive covered services. Deductibles can vary depending upon services received, which Medicare program provides coverage, and income level.

Medicare Part A provides coverage for inpatient hospital care. There is a $1,316 deductible per benefit period as of 2017.

Medicare Part B provides coverage for routine care, including doctor visits. The deductible as of 2017 was $183 annually.

Medicare Part C, or Medicare Advantage, is an optional policy purchased from a private insurer. Deductibles vary depending upon the policy chosen, but a lower deductible means higher premium costs. Some Advantage plans come with prescription drug coverage, so you may be able to buy a Medicare Advantage Plan but forego paying for Medicare Part D.

Medicare Part D provides prescription coverage. Deductibles vary, but the maximum deductible was $400 in 2017.
You could end up paying multiple deductibles if you require services under different parts of Medicare.

2. Medicare premiums

Medicare premiums must be paid, regardless of whether you use healthcare services. Different parts of Medicare come with different premium charges.

Medicare Part A premiums: There are no premiums for Medicare Part A if you are eligible for coverage because of Medicare taxes paid while working. If you aren’t eligible for no-premium coverage, maximum premiums for Medicare Part A are $413 monthly.

Medicare Part B premiums: Premiums vary based on income. Most beneficiaries have premiums deducted directly from Social Security checks. Medicare has Hold Harmless provisions preventing premium increases from exceeding annual Social Security raises under these circumstances. Because of these provisions, average premiums were $109 monthly in 2017 for those paying through Social Security deductions. Standard premiums for all Part B recipients were $134 but could go as high as $428.60 if individual taxable income exceeded $214,000 or joint taxable income exceeded $428,000.

Medicare Part C premiums: Premiums vary by plan for seniors who opt to buy Medicare Part C. Average premiums were around $31.40 monthly for Medicare Advantage plans in 2017. More comprehensive plans carry higher costs.

Medicare Part D premiums: Premiums vary by plan and income level. For example, single adults with income of $85,000 or under pay only their plan premiums while singles with income above $214,000 pay their plan premium + $76.20 monthly.
Medicare premiums routinely exceed Social Security’s annual cost-of-living adjustments. When Social Security beneficiaries do get a raise, it’s often eaten up by increased Medicare costs.

3. Coinsurance costs

Coinsurance costs are costs that must be paid when covered services are used. Coinsurance costs also vary based on the part of Medicare covering services, among other factors.

Patients covered by part A who spend 61 or more days in the hospital must pay a coinsurance cost of $329 per day of each benefit period. Longer hospital stays result in higher coinsurance costs until you have exceeded 60 lifetime reserve days and must pay all costs of hospitalization.

Patients receiving care covered by Part B will owe 20% of the costs of care. Care costs and coinsurance are calculated based on Medicare-approved amounts that are allowed to be paid to caregivers

Patients receiving care covered by part C will have coinsurance costs determined by plan terms.

Patients who obtain prescription drugs through Part D will pay a coinsurance cost based on the selected plan. Some Medicare Part D plans have different tiers for different drug types, with each tier coming with its own coinsurance costs.

Plan ahead to pay for all these Medicare costs

With all these costs, it’s no wonder the Bureau of Labor Statistics reported mean healthcare spending for seniors at almost $6,000 in 2016.

While it would be nice if Medicare actually provided coverage for all the services you need, you’ll have to share the burden of paying for care costs. A health savings account helps keep costs down, but you should still plan ahead for large healthcare costs as a senior if you don’t want to run out of cash during retirement.

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