Everything You Need to Know About Medicare Copayments & Coinsurance

Before you become eligible for Medicare, you probably had some form of health insurance. This means that you might know how monthly copayments work. However, not every insurance plan has coinsurances. Additionally, copayments and coinsurances from standard health insurance plans differ greatly from the copayments required with Original Medicare or even Medicare Advantage. So, how do Medicare copayments and coinsurances work? Read on to learn everything you need to know about Medicare copayments and coinsurances.

What Are Medicare Copayments?

For the uninitiated, Medicare copayments may seem a little complicated. Remember that Original Medicare is divided into Part A and Part B. If you are 65 years or older and either you or your spouse worked for at least 10 years, you qualify for premium-free Part A coverage. If you do not qualify, you will need to pay premiums for Part A which, as of 2021, can go as high as $471 per month.

Alternatively, Part B always requires premiums. If you signed up for Part B during your Initial Enrollment Period, you can expect to pay $148.50 (or more depending on your income) per month in 2021. However, if you failed to sign up when you first became eligible, you may be subject to a Part B penalty premium, which usually requires you to pay an additional 20% every month.

What Are Medicare Coinsurances?

Fortunately, Medicare coinsurance is not as complicated as it sounds. In essence, it’s just the share of medical costs that you must pay after you meet your deductible. For example, in 2021, the Part A deductible is $1,484 per benefit period. Once you pay this amount in medical expenses, your coinsurance will vary based on how many days you’ve spent in an inpatient facility:

• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $371 coinsurance per day
• Days 91 and after: $742 coinsurance per each “lifetime reserve day” — up to 60 days over your lifetime
• After lifetime reserve days: all costs

Part B coinsurance works differently than Part A. With Part B, you must pay a deductible of $203 during each benefit period. After you’ve paid your deductible, you will share the remainder of your medical costs for the period at a ratio of 80:20. You pay 20% of the costs, while Medicare pays 80%.

The Bottom Line

Copayments and coinsurances are some of the most important elements of your Medicare coverage. If you don’t know how much you’ll need to pay, you may struggle to budget for your medical costs during retirement. Fortunately, Time for 65 can help you updated on all of your Medicare-related costs.

If you’d like to learn more about Medicare copayments and coinsurances or your Medicare coverage options, feel free to fill out this form or give us a call anytime. Time for 65’s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.