Medicare Premiums And Deductibles

May 26th, 2017     Medicare

Here is the snapshot of various costs associated with medicare insurance. We can divide the various costs in two broad categories. First is Premiums, which you pay at the time of taking the insurance and second is out-of-pocket expenses (deductibles, co-payments, co-insurance) which you pay while availing the medical services.

Medicare Part-A (Hospital Insurance)

This medicare insurance is for hospital stay and other inpatient services. Refer to Medicare Part-A for more information.

Part A Premium

You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A” and most people get premium-free Part A. If you are not eligible for premium-free Part-A then you’ll have to pay the premium for part-A coverage. The premiums will be as per the table below –

Duration for which medicare taxes are paid You pay (per month)
Equal or more than 40 quarters $0 (Premium-free)
30-39 quarters $227
Less than 30 quarters $413

Part-A Hospital Inpatient Deductibles And Coinsurance

 Deductibles (2017) You pay $1,316 for each benefit period
 Coinsurance (2017) Days 1-60  $0 for each benefit period
Days 61-90  $329 for each benefit period
Days 91 and beyond  $658 coinsurance per each “lifetime reserve day” after day 90 for each benefit period
 Beyond lifetime reserve days  All costs

Part-B (Medical Insurance)

This part of medicare is for paying doctor’s fees and other out-patient services. Refer to Medicare Part-B for more information.

Part-B Premiums

The standard Part B premium for 2017 is $134, however, it can be more for high income individuals. Also, most people who get Social Security benefits will pay less than this amount ($109 on average). You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment.

Part-B Premium Based On Your Income

File individual tax return File joint tax return File married & separate tax return You pay each month (in 2017)
$85,000 or less $170,000 or less $85,000 or less $134
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $187.50
above $107,000 up to $160,000 above $214,000 up to $320,000 Not applicable $267.90
above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 and up to $129,000 $348.30
above $214,000 above $428,000 above $129,000 $428.60

Part B Deductible & Coinsurance

You pay $183 per year for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy and durable medical equipment.

Part-C (Medicare Advantage)

This insurance includes benefits of both part-A and part-B but offered by private insurance companies. Refer to Medicare Part-C for more information.

Monthly Premium Deductibles, Co-payments, & Coinsurance:

You will have to pay a monthly premium (in addition to your Part B premium, although many MA plans comes with $0 monthly premiums). Most medicare advantage plans use a combination of deductibles, co‑insurance and co‑payments to share the costs of care with you. Deductibles, co-pays and co-insurance, plus all costs for ‘services that aren’t covered’ are called “out-of-pocket costs”. Each plan sets its own premium and decides on cost sharing terms. Plans are required to limit the amount you may have to pay out-of-pocket each year. Co-insurance plans set their own co-insurance terms and percentages. The amount you pay for Part C deductibles, co-payments, and/or coinsurance varies by plan and you should check them prior to opting the plan.

Part-D (Medicare Prescription Drug Coverage)

This part includes coverage of prescription drugs costs. Refer to Medicare Part-D for more information.

Medicare Part D premiums

Most Medicare Prescription Drug Plans are provided by private insurance firms which charge a monthly fee that varies by plan. Also, there is a additional premium if you are in the higher income group as shown in the table below. You pay this in addition to the Medicare Part B premium. There will also be a late enrollment penalty which is calculated by multiplying 1% of the national base beneficiary premium ($35.63 per month) by the number of full months you didn’t have Medicare Part D or creditable coverage. That penalty is added to your monthly Medicare Part D premium. The national base beneficiary premium may increase each year, so your late enrollment penalty may likewise increase each year.

Part-D Premiums By Income

File individual tax return File joint tax return File married & separate tax return You pay (in 2017)
 $85,000 or less  $170,000 or less $85,000 or less  your plan premium
 above $85,000 up to $107,000  above $170,000 up to $214,000  not applicable   $13.30 + your plan premium
 above $107,000 up to $160,000  above $214,000 up to $320,000  not applicable  $34.20 + your plan premium
 above $160,000 up to $214,000  above $320,000 up to $428,000  above $85,000 up to $129,000  $55.20 + your plan premium
 above $214,000  above $428,000  above $129,000  $76.20 + your plan premium

Part-D Deductibles, co-payments, & coinsurance:

The annual deductible for a standard Medicare Part D Prescription Drug Plan is a maximum of $400. Medicare Prescription Drug Plans may have a lower deductible than that or even have a $0 deductible. Premiums and deductibles may vary depending on the specific Medicare plan option you select. Most people only pay their Part D premium with no out-of-pocket expenses for medicines.


Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.