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AARP Medicare Question and Answer Tool
DOES MEDICARE COVER ALL MY HEALTH CARE COSTS?
--------------------------------------------------------------------------------
By
Kimberly Lankford,
AARP
1 Comments
En español
Published December 28, 2022
/ Updated October 18, 2023
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No. Even though Medicare can cover many of your health care costs, you’ll still
have some out-of-pocket expenses, including premiums, deductibles, copayments
and coinsurance.
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Though original Medicare doesn’t pay for some of the care you need, such as most
dental, hearing and vision services, it does offer almost universal coverage to
adults 65 and older. Fewer than 1 percent were uninsured in 2021 versus more
than half before Medicare started paying benefits in 1966. Yet for 1 in 5 adults
of Medicare age, out-of-pocket health care costs in 2021 exceeded $2,000,
according to a survey from the Commonwealth Fund.
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Here’s a breakdown of Medicare-covered expenses by each part or plan and what
you may need to pay yourself.
WHAT ARE THE COSTS FOR MEDICARE PART A?
Premium. Most people don’t pay premiums for Medicare Part A, which
covers inpatient stays in hospitals and skilled nursing facilities, some home
health services and end-of-life hospice care. You don’t have to pay Part A
premiums if you or your spouse had Medicare taxes deducted from your paychecks
for at least 40 quarters of work, the equivalent of 10 years or more. The
quarters don’t have to be consecutive.
If you don’t qualify for premium-free Part A, you can choose not to buy it. But
if you do have to pay, you’ll also need to pay for Part B. Part A premiums are:
* $278 a month in 2023 and 2024 if you or your spouse paid 30 to 39 quarters of
Medicare taxes.
* $506 a month in 2023 if you or your spouse paid fewer than 30 quarters of
Medicare taxes, dropping to $505 in 2024.
Deductible. You must pay a $1,600 Part A deductible for each benefit period
you’re hospitalized in 2023, which rises to $1,632 in 2024. A benefit period
begins when you’re admitted to a hospital or skilled nursing facility as an
inpatient and ends when you’ve been out of the hospital or facility for 60 days
in a row.
Coinsurance. You may have to pay a portion of the costs, called coinsurance, if
you stay in a hospital or skilled nursing facility for a long time. Medicare
covers your first 60 days as a hospital inpatient, but in 2023, you pay $400 a
day for days 61 to 90 and $800 a day for up to 60 lifetime reserve days. Those
amounts rise to $408 and $816 in 2024.
Each lifetime reserve day can be used only once but can apply to different
benefit periods. You pay all costs beyond 90 days per benefit period if you use
up your lifetime reserve days.
If you have a qualifying stay in a skilled nursing facility, Medicare can cover
the first 20 days. But you’ll have to pay coinsurance for days 21 to 100, at
$200 a day in 2023; $204 in 2024 and all costs beyond day 100.
If you’re receiving end-of-life care through a hospice program, you may have to
pay up to $5 per prescription for pain and symptom management and 5 percent of
the Medicare-approved amount for respite care.
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WHAT ARE THE COSTS FOR PART B?
Medicare Part B helps pay for doctor visits, diagnostic screenings, lab
tests, preventive care, medical equipment, transportation and other outpatient
services.
Premiums. Most people pay $164.90 a month in 2023 for Medicare Part B
premiums or $174.70 in 2024. People who are single with an adjusted gross income
of more than $97,000, or married filing jointly with income greater than
$194,000, pay a high-income surcharge with premiums ranging from $230.80 to
$560.50 a month in 2023, depending on income level.
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The income level and surcharges rise in 2024. Single filers with income above
$103,000 and joint filers earning more than $206,000 pay a premium that ranges
from $244.60 to $594.00. The surcharge is based on their last tax return on
file, which is generally 2022 for 2024 premiums.
If you don’t enroll in Medicare when you are first eligible or qualify for
a special enrollment period to sign up later, you may have to pay a late
enrollment penalty, which is added to your Part B premiums for as long as you
have the coverage.
Deductible. You’ll have to pay $226 in 2023 before most Part B coverage begins;
that number increases to $240 in 2024.
Coinsurance. After paying the deductible, you generally pay 20 percent of the
Medicare-approved amount, called coinsurance, for most doctor and outpatient
services and for durable medical equipment. Part B covers some preventive
services without a deductible or coinsurance.
WHAT ARE THE COSTS FOR PART C, MEDICARE ADVANTAGE?
Premiums. If you decide to get your Medicare coverage through a private Medicare
Advantage plan instead of original Medicare, you still must pay the monthly
premiums for Part B — and Part A if you don’t qualify for premium-free Part A.
Some Medicare Advantage plans also charge an average of $18.50 a month, although
two-thirds of the plans have no additional premium.
Deductibles and copayments. Medicare Advantage plans must provide at least as
much coverage as original Medicare, but the deductibles and copayments can be
different and vary by plan. All Medicare Advantage plans have an annual cap on
out-of-pocket expenses for services covered under Part A and Part B.
The out-of-pocket limit for Part C plans in 2023 is $8,300 or less for
in-network health services and $12,450 or less for in-network and out-of-network
services combined. Those limits rise to $8,850 and $13,300 in 2024. Some plans
have lower spending ceilings.
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WHAT ARE THE COSTS FOR A PART D PRESCRIPTION DRUG PLAN?
Premiums. Medicare doesn’t automatically cover prescription drugs, but you can
buy a Part D plan from a private insurer. These plans charge a monthly
premium that varies by plan, averaging $55.50 in 2024.
People with higher incomes pay a surcharge that adds $12.20 to $76.40 to
their monthly bills in 2023, and $12.90 to $81 in 2024. If you don’t sign up for
a Part D plan when you’re first eligible and don’t have other similar drug
coverage, you may have to pay a late enrollment penalty.
Deductible, copayments, coinsurance. Part D plans can have a deductible of up to
$505 in 2023 and $545 in 2024. You’ll also have copayments or coinsurance for
your drugs, based on the plan, the medication and how much you’ve spent so far
on prescriptions during the year.
In 2024, you reach the coverage gap — where you have to pay up to 25 percent of
the cost of covered drugs — when you and your insurer have paid $5,030 in drug
costs for the year. You reach the catastrophic phase after you’ve spent $8,000
from your own pocket and, because of a change in law, you don’t have to pay
anything for covered prescription drugs for the rest of the year.
KEEP IN MIND
If you have original Medicare, you may be able to cover many of the
out-of-pocket costs for Part A and Part B by buying a Medicare supplemental
policy, better known as Medigap, from a private insurer.
But you’ll pay for expenses that Medicare doesn’t cover, such as most dental,
hearing and vision care.
If you choose a Medicare Advantage plan instead of original Medicare, the plan
may have different copayments and deductibles than Medicare, and its network of
doctors and other health care providers usually is limited. But the plan may
include some benefits not part of original Medicare, such as dental, hearing and
vision care. These benefits come with their own deductibles and copays.
Financial assistance is available at both the federal and state levels for those
who can’t afford all the costs associated with Medicare.
Return to Medicare Q&A main page
%{postComment}%
Kimberly Lankford is a contributing writer who covers Medicare and personal
finance. She wrote about insurance, Medicare, retirement and taxes for more than
20 years at Kiplinger’s Personal Finance and has written for The Washington
Post and Boston Globe. She received the personal finance Best in Business award
from the Society of American Business Editors and Writers and the New York State
Society of CPAs’ excellence in financial journalism award for her guide to
Medicare.
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MEMBERS ONLY
Health & Wellness
AARP® Dental Insurance Plan administered by Delta Dental Insurance Company
Dental insurance plans for members and their families
Learn More
See more Health & Wellness offers >
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Health & Wellness
The National Hearing Test
Members can take a free hearing test by phone
Learn More
See more Health & Wellness offers >
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Health & Wellness
AARP® Staying Sharp®
Activities, recipes, challenges and more with full access to AARP Staying Sharp®
Learn More
See more Health & Wellness offers >
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234
*
*
*
*
* Magazines & Resources
AARP Rewards
Learn, earn and redeem points for rewards with our free loyalty program
Learn More
See more Magazines & Resources offers >
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* MEMBERS ONLY
Health & Wellness
AARP® Dental Insurance Plan administered by Delta Dental Insurance Company
Dental insurance plans for members and their families
Learn More
See more Health & Wellness offers >
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* Health & Wellness
The National Hearing Test
Members can take a free hearing test by phone
Learn More
See more Health & Wellness offers >
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