Most Medicare recipients pay the standard Medicare Part B deductible of $170.10 each month, but others may pay more or less, depending on income.
Other Medicare Part B costs include the annual Part B deductible ($233 in 2022) and coinsurance (typically 20% out-of-pocket) for many covered services.
Medicare Part B has no out-of-pocket maximum, and neither does Medicare Part A which could get costly for beneficiaries requiring an expensive service.
A Medicare Supplement Plan (Medigap) can help some Medicare beneficiaries manage Part B costs.
How Much Will Medicare Part B Cost Most Beneficiaries?
Part B of Original Medicare covers many medically necessary and preventative healthcare services. Most beneficiaries on Part B will pay the standard Medicare premium of $170.10 a month. In addition to the monthly premium Part B participants should also expect to incur out-of-pocket costs from deductibles and coinsurance (shared percentage of costs) like other insurance plans. Original Medicare Part A and B enrollees won’t have a copay (flat-rate costs) for services; however copays can be recognized for individuals enrolled in Medicare Advantage Part C or Part D. Typical Medicare Part B services include doctor visits, preventive care, medical equipment, and laboratory tests.
For more information on Part B costs visit Medicare Part B in Detail.
What Kind of Part B Out-of-Pocket Costs Should the Average Enrollee Expect?
The standard $170.10 monthly premium is often deducted from Social Security Income. Single taxpayers or couples with higher incomes may pay more for their monthly Part B premiums. Part B surcharges begin with incomes for single taxpayers over $91,000 and incomes for married couples who file jointly over $182,000 in 2022.
There are certain scenarios where Part B expenses can amount to thousands of dollars for the enrollee since Original Medicare doesn’t offer an out-of-pocket limit. Some Medicare insurance plans, like Medigap or Medicare Advantage, may help beneficiaries manage these expenses.
The Medicare premium and surcharges may change every year. CMS announced a substantial increase in the standard premium for 2021 from $148.50 to $170.10 in 2022. The agency’s rationale for the price hike was due to increased costs, notably caused by the COVID-19 pandemic. Other factors included a limit on premium adjustments in 2021 because of the pandemic, concerns over the costs of certain new drugs, and generally rising healthcare costs.
In contrast, low-income earners may pay lower premiums and less for other Medicare costs. Financial assistance may come from qualifying for Medicaid or other state-run Medicare Savings Programs. These programs and their eligibility rules can vary by state.
The Annual Medicare Part B Deductible
Besides the monthly Part B premium, Medicare Part B also has an annual deductible of $233 in 2022. Beneficiaries need to pay this amount for most covered services each year before Part B pays its share.
The deductible can also change every year. For 2021, CMS set the deductible at $203, so this cost has also increased substantially since last year. Historically, the deductible only rises a few dollars each year or remains the same, and it has even declined upon occasion.
How Much Does Medicare Part B Cost-Sharing (Coinsurance) Cost?
Besides the premium and annual deductible, beneficiaries with Original Medicare may have to pay for many covered services. For instance:
- Medicare Part B covers most services at 80%, leaving the beneficiary responsible for 20%. So actual out-of-pocket costs will vary depending upon the costs of services rendered for a particular beneficiary.
- Medicare Part B offers some preventative services without out-of-pocket coinsurance costs and before meeting the annual deductible. Examples include covered depression screening, laboratory tests, and qualified home healthcare.
Neither Medicare Part A nor Part B offers any out-of-pocket limits. Thus, people who need many healthcare services could end up with high medical bills, even with Medicare coverage.
Can Medicare Supplement Plans (Medigap) Help Manage Part B Costs?
Most Medigap plans can help offset the remaining out-of-pocket costs from coinsurance. People with Medicare Supplement plan will likely pay a premium for this insurance policy but it may be worth the premium expense for individuals that would have incurred even greater expenses by having to pay their portion of the coinsurance. Medigap policies can help pay for Medicare-related copayments, coinsurance, and deductibles.
- How coinsurance costs can get expensive: The National Library of Medicine estimates that respiratory therapy for patients who suffer from COPD and other lung issues can cost between $5,000 to over $11,000 a year. That expense could generate yearly Part B coinsurance costs of $1,000, $2,000, or more.
How Do Medicare Advantage Plans Cover the Part B Copay?
Medicare Advantage plans give beneficiaries an alternative way to receive their Medicare Part A and B benefits. Since private insurers offer Medicare Advantage plans, beneficiaries should compare the potential costs of any plan they’re considering to Original Medicare. Medicare Advantage plans will cover Part B expenses, but they might also have copays and deductibles. Most of these plans should reduce out-of-pocket expenses but may limit plan members to choosing in-network services.
Medicare Advantage plans will also provide members with an annual out-of-pocket maximum. Once the beneficiary meets this maximum in expenses, the program will continue to pay for covered services at 100 percent. According to the Kaiser Family Foundation, out-of-pocket limits in 2022 averaged about $5,000.
- Medicare Part B Premiums, CMS.
- The Costs of Long-Term Oxygen Therapy, Pub Med.