Medicare Insurance Costs

Part A Monthly Premium

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

• $505/month for those with fewer than 30 quarters of Medicare-covered employment
• $278/month for those with 30-39 quarters of Medicare-covered employment

Beneficiary Pays for Skilled Nursing Facility Stay

• $0 for the first 20 days of each benefit period
• $204.00 per day for days 21–100 of each benefit period
• All costs for each day after day 100 of the benefit period

Part B Monthly Premium

Most people pay the standard Part B premium amount which is $174.70 in 2024

• If your income was more than $91,000 ($182,000 filing joint) you’ll pay $244.60
• If your income was more than $114,000 ($228,000 filing joint) you’ll pay $349.40
• If your income was more than $142,000 ($284,000 filing joint) you’ll pay $454.20
• If your income was more than $170,000 ($340,000 filing joint) you’ll pay $559
• If your income was more than $500,000 ($750,000 filing joint) you’ll pay $594

Medicare Advantage plans combine Part A and B into one plan and are offered by Medicare-approved health insurance companies as an alternative option to your Original Medicare coverage. Premiums and out-of-pocket costs may vary depending on your plan, however some premiums can be as low as $0, in addition to your monthly Medicare Part B premium (see above). To ensure you find a plan that fits your specific healthcare needs and budget, please contact our licensed Medicare agent for professional assistance.

Monthly Premiums

Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (Part C) or Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.

• If your income was more than $91,000 ($182,000 filing joint) you’ll pay $12.90 + your plan premium
• If your income was more than $114,000 ($228,000 filing joint) you’ll pay $33.30 + your plan premium
• If your income was more than $142,000 ($284,000 filing joint) you’ll pay $53.80 + your plan premium
• If your income was more than $170,000 ($340,000 filing joint) you’ll pay $74.200 + your plan premium
• If your income was more than $500,000 ($750,000 filing joint) you’ll pay $81.00 + your plan premium

Deductibles vary between Medicare drug plans. Some Medicare drug plans don’t have a deductible.

• No Medicare drug plan may have a deductible more than $545 in 2024.
• Once your deductible is met, you’ll pay a coinsurance (copay) for prescription drugs. Note that the amount of your copay may change during the benefit period, if the drug price fluctuates.
  • Initial coverage limit is $5,030 (plan pays 75% – you pay 25%)
  • Once you and your plan pay this amount, you’ll continue to pay 25% of the cost of your prescriptions drugs until you reach your threshold
  • Annual out-of-pocked threshold is $8,000

Coverage Gap – Donut Hole

Once you and your plan have spent $5,030 covered drugs in 2023, you’re in the coverage gap (a temporary limit on what the plan covers). Even though you’ll only pay 25% for both brand name and generic drugs at this point, almost the full price of the drug (except for what the plan pays) will count as out-of-pocket costs to help you get out of the coverage gap.

• The manufacturer pays 70% of drug costs
• The plan pays 5% of drug costs
• You pay 25% of drug costs
• The plan also pays 75% of a dispensing fee, you pay 25% of the dispensing fee

Catastrophic Coverage

Once you reach your threshold ($8,000), you are out of the coverage gap (donut hole) and you’ll automatically get catastrophic coverage. This assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

• You’ll pay 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year.
• Your plan pays the rest

Insulin Costs

Beginning Jan. 1, 2023 and beyond, all Medicare Part D and Medicare Advantage plans with prescription coverage will cap the cost of select insulin products at $35.

With this change, you’ll pay no more than $35 for a month’s supply of insulin.

Starting on July 1, people on Original Medicare who use an insulin pump will also pay no more than $35 for a month’s supply of insulin.

Vaccine Costs

Starting in 2023 and beyond, vaccines covered under Medicare Part D will be free.

This means you pay no deductible, coinsurance or copay for vaccines — even the shingles vaccine — covered by Medicare Part D.