Understanding My Medicare
A, B and D
Medicare Part A and B, Medicare Part D
Part A Monthly Premium
Most people don’t pay a premium for Part A because they paid Medicare taxes while working. As of 2020, you can pay up to $471 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 $148.50 (or higher depending on your income). Social Security will tell you the exact amount you’ll pay for Part B in 2021.
You’ll pay a different premium amount if:
- You enroll in Part B for the first time in 2021.
- 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 $148.50)
- 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 6 groups, here’s what you’ll pay:
If your yearly income in 2019 (for what you pay in 2021) was:
File married &
separate tax return
$87,000 or less
$174,000 or less
$87,000 or less
up to $109,000
up to $218,000
up to $136,000
up to $272,000
up to $163,000
up to $326,000
and less than $500,000
and less than $750,000
and less than $413,000
$500,000 or above
$750,000 and above
$413,000 and above
Part A costs for Covered Services and Items
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
- $0 for covered home health care services
- 20% of the Medicare-approved amount for durable medical equipment (dme) (DME).
- $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)
- Doesn’t cover room & board when you get hospice care in your home or another facility where you live like a nursing home
Hospital Inpatient Stay
- $1,484.00.00 deductible and no coinsurance for days 1-60 each benefit period
- $371.00 per day for days 61-90 each benefit period
- $742.00 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
- 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.
- There’s no limit to the number of benefit periods you can have when you get mental health care in a general hospital. You can also have multiple benefit periods when you get care in a psychiatric hospital. Remember, there’s a lifetime limit of 190 days.
Skilled Nursing Facility Stay
- $0 for the first 20 days each benefit period
- $185.50 coinsurance per day for days 21-100 of each benefit period
- All costs for each day after day 101 in a benefit period
Part B Costs for Covered Services and Items
Part B Deductible
You pay $203.00 per year in 2021 for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for these.
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 for durable medical equipment (dme).
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.
Mental Health Services
You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment. 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. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional co-payment or coinsurance amount to the hospital.
Other Covered Services
You pay co-payment and coinsurance amounts.
Outpatient Hospital Services
You usually pay 20% of the Medicare approved amount for the doctor or other health care provider’s services. For services that can also be provided in a doctor’s office, you may pay more for outpatient services you get in a hospital than you’ll pay for the same care in a doctor’s office. However, the hospital outpatient co-payment for the service is capped at the inpatient deductible amount. In addition to the amount you pay the doctor, you’ll also usually pay the hospital a co-payment for each service you get in a hospital outpatient setting except for certain preventive services that don’t have a co-payment. In most cases, the co-payment can’t be more than the Part A hospital stay deductible for each service. The Part B deductible applies, except for certain preventive services. If you get hospital outpatient services in a critical access hospital, your co-payment may be higher and may exceed the Part A hospital stay 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)
- Most dental care
- Eye exams related to prescribing glasses
- Cosmetic surgery
- Hearing aides and exams for fitting them
- Routine foot care
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 ($33.06 in 2021) times 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. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
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UNDERSTANDING MY MEDICARE
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Fax: (503) 987-1769
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