Monthly Premiums

Part A Monthly Premium

Most people don’t pay a premium for Part A because they paid Medicare taxes while working.   As of 2018, you can pay up to $422 each month for Part A if you don’t qualify to get it premium-free. If you pay a late enrollment penalty, this amount is higher.

Note: If you don’t get Social Security, RRB, or Civil Service benefit payments, and choose to sign up for Part B, you will get a bill. If you choose to buy Part A, you will always get a bill for your premium.

How much does Part B cost?

Part B premiums

You pay a premium each month for Part B. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

The standard Part B premium amount is $134.00 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount. If you pay your Part B premium through your monthly Social Security benefit, you’ll pay less ($130 on average). Social Security will tell you the exact amount you’ll pay for Part B in 2018.

You’ll pay a different premium amount if:

You enroll in Part B for the first time in 2018.
You don’t get Social Security benefits.
You’re directly billed for your Part B premiums.
You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $134.00.)
Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

If you’re in 1 of these 5 groups, here’s what you’ll pay:

If your yearly income in 2016 (for what you pay in 2018) was			You pay (in 2018)
File individual tax return	File joint tax return	File married & separate tax return	You pay (in 2018)
$85,000 or less	$170,000 or less	$85,000 or less	$134.00
above $85,000 up to $107,000	above $170,000 up to $214,000	Not applicable	$187.50
above $107,000 up to $133,500	above $214,000 up to $267,000	Not applicable	$267.90
above $133,500 up to $160,000	above $267,000 up to $320,000	Not applicable	$348.30
above $160,000	above $320,000	above $85,000	$428.60

Part A costs for Covered Services and Items

Blood	If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 pints of blood you get in a calendar year or have the blood donated by you or someone else.. In most cases, the hospital gets blood from blood bank at no charge, and you won’t have to pay for it or replace it.
Home Health care	You pay: $0 for covered home health care services 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare-covered medical equipment
Hospice Care	You pay: $0 for hospice care A co-payment of up to $5.00 per prescription for outpatient prescription drugs for pain and symptom management. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest)
Hospital Inpatient Stay	You pay: $1,340.00 deductible and no coinsurance for days 1-60 each benefit period $335.00 per day for days 61-90 each benefit period $670.00 per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime) All costs for each day after the lifetime reserve days Inpatient mental health care in a psychiatric hospital limited to 190 days in a lifetime.
Skilled Nursing Facility Stay	You pay: $0 for the first 20 days each benefit period $167.50 per day for days 21-100 each benefit period All costs for each day after day 100 in a benefit period

Part B Costs for Covered Services and Items

Part B Deductible	You pay the first $183.00 yearly for Part B-covered service items.
Blood	In most cases, the provider gets blood from the blood bank at no charge, you won’t have to pay for it or replace it. However, you will pay a co-payment for blood processing and handling service for every unit of blood you get, and the Part B deductible applies. If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.
Clinical Laboratory Services	You pay $0 for Medicare-approved services
Home Health Services	You pay $0 for covered home health services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare-covered medical equipment.
Medical and Other Services	You pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you are a hospital inpatient), outpatient therapy*, and durable medical equipment. Note: In 2018 there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.
Mental Health Services	You pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible applies.
Other Covered Services	You pay co-payment and coinsurance amounts.
Outpatient Hospital Services	You pay a coinsurance (for doctor services) or co-payment amount for most outpatient hospital services and the Part B deductible applies. The co-payment for a single service can’t be more than the amount of the inpatient hospital deductible.

WHAT’S NOT COVERED BY PART A AND PART B?

Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to take care of the cost. Even if Medicare covers the service or item, you will generally have to pay deductibles, coinsurance, and co-payments on those services.   Some of the items and services that Medicare doesn’t cover include the following:

Long-term care (also called custodial care)
Routine dental care or eye care
Dentures
Cosmetic surgery
Acupuncture
Hearing aides
Exams for fitting hearing aids

Part D Prescription Drug coverage

Medicare offers prescription drug coverage with Medicare. If you decide not to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other credible prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Part D Coverage. The late enrollment penalty is 1% of the national base beneficiary premium ($35.63 in 2017) by the number of full uncovered months that you were eligible but didn’t join a Medicare drug plan and went without other credible prescription drug coverage.

Medicare Part A, B and D