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Your Medicare Costs

Four words you need to know

Understanding Medicare costs is a big part of choosing the coverage that’s right for you. You’ll see four words over and over again that have special meaning in Medicare. Mastering them will pay off.

  • Premium
  • Deductible
  • Copayment
  • Coinsurance

You pay premiums outright. Deductibles, copayments and coinsurance are ways that Medicare shares the cost of your care with you.

Medicare’s reasoning is simple. If you pay some of the cost of the health care you use, then you may be more likely to use it wisely. You also may be motivated to do things that help keep you healthy. This can reduce your health care costs.

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Understanding your plan benefits can help you save on your health care expenses and can make a big difference on your pocketbook. Get some tips on how to get the most out of your plan today.

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A premium is a fixed fee that you pay for your Medicare coverage. You may pay a premium to Medicare, to a private insurance company or to both, depending on the coverage you choose. Most premiums are charged monthly.

Medicare premium graphic


A deductible is an amount that you have to pay out-of-pocket before your plan will begin to pay some of your health care costs. Deductibles are charged annually by Part B and most private Medicare plans. Part A charges a deductible for each benefit period In Medicare Part A, a benefit period begins the day you go into a hospital or skilled nursing facility. It ends when you have been out for 60 days in a row. You may be in the hospital more than once during one benefit period. There is no limit on the number of benefit periods that Medicare will cover. Part A charges a deductible for each benefit period. .

Medicare deductible graphic


A copayment, or copay, is a fixed amount you pay each time you use a service or purchase a product. For example, you may pay $10 or $20 each time you go to the doctor or fill a prescription.

Medicare copayment graphic


Coinsurance is when you split the cost of a service or product. For example, you pay 20% of the Medicare-approved amount The amount Medicare determines to be reasonable for a covered service. Providers who “accept assignment” agree to accept this amount as payment in full. Providers who accept Medicare but not assignment can charge up to 15% above this amount. and Medicare pays 80%.

Medicare coinsurance graphic

Cost-sharing Considerations

It’s easy to focus only on monthly premiums when looking at Medicare costs. Premiums are regular monthly expenses that have to fit into a budget. And most of us are keenly aware of our monthly expenses.

But it’s a good idea to look at the big picture, too. For example, a plan with a lower monthly premium might end up costing you more. You may have to pay a large deductible or you might have high copayments for your doctor visits or prescriptions.

When you’re looking at your coverage and plan choices, be sure to consider all the costs. Think about how you will use your benefits, too. For example, low copayments might not be important to you if you don’t go to the doctor much or take many medications.