I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
Answered by 19 licensed agents
Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
Answered by Diana Garner on April 29, 2025
Broker Licensed in KY, FL, IN, OH & TN
Answered by Nikki Rowland on May 5, 2025
Broker Licensed in SC & NC
Answered by Steven Bleicher on May 24, 2025
Broker Licensed in AZ
Deductibles are the amount you need to pay out of pocket BEFORE your benefits take place. And Co-Insurance or Co-Pays are the required payment directly to the functionary that keeps the insurance rates lower for the insured. It seems a little redundant I know, but little things like a Co-pay sometimes stop the abuse of the system once someone has met their deductible.
Answered by Norman Smith on May 21, 2025
Agent Licensed in FL & PA
Answered by DeeDee Whitlock on April 16, 2025
Broker Licensed in LA
Deductibles are the money you pay before a plan pays for services. Generally, these payments count towards your maximum out-of-pocket.
Copays (and co-insurances) are the costs of your services and count toward your maximum out-of-pocket.
You can find specific amounts in your plan's summary of benefits document.
Answered by Don Golding on April 7, 2025
Broker Licensed in TX, AL, AR & 5 other states
Elaboration:
Premiums:
These are the monthly fees you pay to maintain your Medicare coverage, both for Part A (hospital) and Part B (medical).
Deductibles:
Before Medicare begins to pay for services, you'll usually have to pay an annual deductible for Part A and Part B. For example, in 2025, the Part A deductible for hospital stays is $1,676.
Copays:
These are fixed amounts you pay for specific services, like a doctor's visit or a prescription. For example, you might pay $20 for a doctor's visit or $30 for a prescription.
Coinsurance:
This is a percentage of the cost you pay for services after you've met your deductible. For example, you might pay 20% of the cost of a hospital stay after you've paid your deductible.
How they work together:
Pay Premiums: You pay monthly premiums to ensure your Medicare coverage is active.
Meet Deductible: Before Medicare pays for most services, you'll need to meet an annual deductible.
Pay Copays/Coinsurance: After meeting the deductible, you'll pay copays (fixed amounts) or coinsurance (a percentage) for each service.
In simpler terms:
Think of it like car insurance. You pay a monthly premium to keep your coverage active. If you get in an accident, you pay a deductible before your insurance kicks in to cover the rest of the repair costs. Similarly, with Medicare, you pay monthly premiums, meet a deductible, and then pay copays or coinsurance for your healthcare.
Answered by Fred Manas on May 16, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Steve Brauer on April 14, 2025
Broker Licensed in AZ & CA
Answered by Gary Henderson on April 29, 2025
Agent Licensed in TX, AK, AL & 46 other states
My name is 940-395-6572 and my name is Marcie Barnes. I would be happy to break everything down in simple terms for you
Answered by Marcie Barnes on April 19, 2025
Agent Licensed in TX, AK, AL & 48 other states
Deductibles are what you pay first before Medicare kicks in.
Copays/coinsurance are your share of the cost after that.
Answered by Sam Silva on April 10, 2025
Broker Licensed in FL, GA, NJ & 7 other states
Answered by Aisha Saleem on June 1, 2025
Agent Licensed in MD & FL
Answered by Ellen Diehl on April 3, 2025
Broker Licensed in GA
Answered by Robert Rowe on May 12, 2025
Broker Licensed in MI
Answered by Charles Borg on April 9, 2025
Agent Licensed in FL & NY
Answered by Dominic Javier on April 29, 2025
Broker Licensed in TX
Answered by Sophia Davis on April 16, 2025
Agent Licensed in OH
Deductibles are the amount you have to pay before the plan you enroll in begins to pay. Not all plans have deductibles and not all deductibles apply to all services.
Copays are the dollar amounts you have to pay your providers.
Coinsurance is the percentage you have to pay your providers. This is one or the other, not both.
Examining your needs and budget is the best way to make a choice!
Answered by Jacquie Wolf on June 1, 2025
Broker Licensed in NY
Answered by Christine Itami on May 19, 2025
Broker Licensed in AZ, FL, ID & 5 other states
Tags: New To Medicare
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