Part A (Hospital Insurance)
per benefit period
$389/day for days 61-90
$778/day per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
Skilled Nursing Facility Copayment
- $0 for the first 20 days of each benefit period
- $194.50/day for days 21-100
- All costs for each day after day 100 of the benefit period
Part A Premiums
Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
$499/month for those with fewer than 30 quarters of Medicare-covered employment
$274/month for those with 30-39 quarters of Medicare-covered employment
Part B (Medical Insurance)
per benefit period
Part B Premium
$170.10/month – standard Part B Premium
Most Part B covered services*
20% of amount Medicare approves
*Part B: covers Medicare eligible physician services, outpatient hospital services, outpatient mental health services, certain home health services, durable medical equipment
MEDICARE PART C – ADVANTAGE PLANS
Medicare Advantage plans combine Part A and B into one plan.
Offered as a alternative to original Medicare, these plans are sold and serviced by Medicare-approved health insurance companies as an alternative option to your Original Medicare coverage. Premiums and out-of-pocket costs may vary depending on your plan, however most people pay as low as $0 to $25 in addition to your monthly Medicare Part B premium (see above). To ensure you find a plan that fits your specific healthcare needs and budget, please contact our licensed Medicare agent for professional assistance.
MEDICARE PART D – PRESCRIPTION DRUGS
Monthly Premiums for Medicare Part D
For 2022 Medicare Part D Costs, most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (Part C) or Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.
- If your income was more than $91,000 ($182,000 filing joint) you’ll pay $12.40 + your plan premium
- If your income was more than $114,000 ($228,000 filing joint) you’ll pay $32.10 + your plan premium
- If your income was more than $142,000 ($284,000 filing joint) you’ll pay $51.70 + your plan premium
- If your income was more than $170,000 ($340,000 filing joint) you’ll pay $71.30 + your plan premium
- If your income was more than $500,000 ($750,000 filing joint) you’ll pay $77.90 + your plan premium
Deductibles vary between Medicare drug plans. Some Medicare drug plans don’t have a deductible.
-No Medicare drug plan may have a deductible more than $480 in 2022.
CoPayments and Out-of-Pocket Threshold
Once your deductible is met, you’ll pay a coinsurance (copay) for prescription drugs. Note that the amount of your copay may change during the benefit period, if the drug price fluctuates.
-Initial coverage limit is $4,430 (plan pays 75% – you pay 25%)
-Once you and your plan pay this amount, you’ll continue to pay 25% of the cost of your prescriptions drugs until you reach your threshold
-Annual out-of-pocked threshold is $7,050
Coverage Gap - Donut Hole
Once you and your plan have spent $4,430 on covered drugs in 2022, you’re in the coverage gap (a temporary limit on what the plan covers). Even though you’ll only pay 25% for both brand name and generic drugs at this point, almost the full price of the drug (except for what the plan pays) will count as out-of-pocket costs to help you get out of the coverage gap.
-The manufacturer pays 70% of drug costs
-The plan pays 5% of drug costs
-You pay 25% of drug costs
-The plan also pays 75% of a dispensing fee, you pay 25% of the dispensing fee
Once you reach your threshold ($7.050), you are out of the coverage gap (donut hole) and you’ll automatically get catastrophic coverage. This assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
-You’ll pay 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year.
-Your plan pays the rest
The above information was obtained from Medicare.gov.
Note that O’Brien & Associates, and Larry O’Brien are not part of the Federal Medicare program.