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Premiums, Deductibles & Coinsurance: What’s the Difference?

For those who are new to Medicare, or even for those who have had Medicare for a while, you know that insurance lingo can be quite confusing. It’s important that you familiarize yourself with some key terms so you know exactly what your coverage includes and which costs you will have to pay out of pocket.

Specifically, it is important to differentiate between premiums, deductibles and coinsurance.

Medicare Premiums

A premium is the monthly amount you will pay for your Medicare coverage. The amount you will pay depends on how long you worked and paid Medicare taxes, as well as your income level.

Part A Premiums

The majority of Medicare beneficiaries over age 65 will not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working for 10 years or 40 quarters. If you do not qualify for premium-free Part A, you may have to pay a premium of up to $413 each month.

Part B Premiums

The standard Medicare Part B premium is set each year by CMS. The amount you pay will vary depending on your situation, including when you signed up for Part B.

It’s also important to note that if you wait to enroll in Part B, your premium could be 10% higher for every 12-month period that you were eligible for Part B but did not sign up.

Medicare Deductibles

A deductible is the amount you must pay out-of-pocket each year before your Medicare plan will begin offering coverage for your medical expenses. CMS updates both Part A and Part B deductibles each year.

Part A Deductible

Medicare Part A helps cover hospital, skilled-nursing facility, and home health-care services once you meet your Part A deductible. For 2018, the Medicare Part A deductible is $1,340 for each benefit period.

Part B Deductible

Medicare Part B helps cover physician services, outpatient hospital services, certain home health services, and covered durable medical equipment once you meet your Part B deductible. For 2018, the Medicare Part B deductible is $183 for each benefit period.

Medicare Coinsurance

Coinsurance is what you, the patient, pay as your share toward a claim. It is a form of cost-sharing between the insurance company and the consumer. You will typically begin paying your coinsurance after you meet your annual deductible. It is usually a percentage of the total cost.

Part A Coinsurance

For hospital visits, you will pay $0 in coinsurance for the first 60 days. For days 61-90, you will pay $329 per day in coinsurance. For days 91 and beyond, you will pay $658 per day in coinsurance.

For skilled-nursing facility stays, you will pay $0 in coinsurance for the first 20 days. For days 20-100, you will pay $164.50 per day in coinsurance. For days 101 and beyond, you are responsible for all costs.

Part B Coinsurance

Once you have met your Part B deductible, you will be required to pay a coinsurance of 20% of all Medicare-approved charges by providers for your health-care services. This will be your biggest threat to out-of-pocket expenses.

In the case of a major-medical event, you could owe tens of thousands of dollars in medical expenses if you don’t have secondary insurance, like a Medicare supplement plan, to help cover those costs for you.

GoMedigap Can Help

If you are confused with Medicare or need some help navigating the various enrollment periods, we can help you. GoMedigap agents are professionally trained Medicare experts and can help educate you on Medicare and guide you in the right direction. To speak with a Medicare expert, call us directly at (866) 894-3258.

Compare Your Medicare Supplement Rates Immediately!

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