How to Evaluate Medicare Plan CostsPosted by Medicare Made Clear
Medicare shares the cost of your care with you. What you pay depends on what Medicare plan you have and how you use it.
Your cost sharing may include some or all of the following:
Premium: A fixed fee that you pay—usually monthly—to your plan, to Medicare or to both.
Deductible: An amount that you have to pay out-of-pocket before your plan will begin to pay some of your health care costs.
Copayment (copay): A fixed amount—typically $10 or $20—that you pay each time you see your doctor, fill a prescription or use other covered services.
Coinsurance: A percentage of the cost for a service or product—usually 20%—that you pay. Your plan pays the rest.
It may be helpful to look at how these different types of cost-sharing work together. For example, plan premiums generally go down as deductibles go up. The plan charges you less each month, and you pay more out-of-pocket for the services you use. The reverse is also true. As premiums go up, deductibles may go down. Also, plans usually charge a copayment or coinsurance for any given service—not both. Copayments may be less than coinsurance amounts for the same service.
You need to look at all the costs charged by the Medicare plan you have or are thinking of getting. You also need to consider how you use health care and your Medicare benefits.
Looking at plan costs and your health care usage together will give you an idea of your out-of-pocket costs. This can help you decide which plan provides the coverage you need at a price you are comfortable with. Here are a few questions to get you started:
How often do you visit the doctor? Do you have a copay each time you go? How much is it?
What does your doctor charge for an office visit? It’s worth knowing. If your plan charges coinsurance, then you will pay a portion of your doctor’s fee.
What prescription medications do you regularly take? How much do you pay to fill a prescription?
Do you have a chronic condition that requires regular monitoring and supplies, such as diabetes? What do you pay for supplies?
Do you travel frequently or live part of the year in a different state? Is your care covered when you are away?
Do you have a particular doctor you like to see? Does your doctor accept the amount Medicare pays for services as payment in full?
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
Medicare Costs: Information about costs with Original Medicare, Medicare Advantage and other Medicare plans
Medicare Choices Summary chart: MedicareMadeClear.com
2012 Medicare costs: Costs with Original Medicare at Medicare.gov
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