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Medicare Costs

Medicare Costs

Medicare costs include more than just monthly premiums; the amount you pay depends on the coverage you choose and the health care services you receive. And, you may qualify for help with your Medicare costs.

What is a Premium?

A premium is a set amount (often monthly) you must pay for coverage. Depending on which type of coverage you choose, you may pay a premium to Medicare, to a private insurance company like RMHP, or both.

Which Costs Might I Share with Original Medicare or My Plan?

"Cost sharing" is a term used to describe the way Original Medicare or your plan shares your health care costs with you. The most common types of cost sharing are:


  • Deductible

    This is a set amount that you pay out-of-pocket for covered services before Medicare, your Medicare Advantage plan, and/or your Prescription Drug plan start to pay. If you have a Medicare Supplement insurance plan, this is the amount your plan may help pay after Medicare pays, depending on the plan you choose.

    With a deductible, you pay first up to the deductible. Then, Medicare and/or your plan begins to pay.

  • Copayment (copay)

    An amount you may be required to pay as your share for the cost of a covered service. For example, if you have prescription coverage, you might pay $10 each time you fill a certain prescription. If you have a Medicare Supplement plan, copays paid by the plan are either paid in full or a percentage of the copay is paid, depending on the plan you choose.

    With a copay, you pay a fixed amount. Then, Medicare Advantage or Prescription Drug plans will be billed for the rest.

  • Coinsurance

    The amount you may be required to pay as your share for the cost of a covered service. For example, Medicare Part B pays about 80% of the cost of a covered medical service and you would pay the rest.

    There are Medicare Supplement Insurance Plans with low to no coinsurance options. Depending on the plan you choose, you may get help paying the Part A and/or Part B coinsurance amounts.


Are there out-of-pocket costs and limits to out-of-pocket spending?

The out-of-pocket maximum is the maximum amount you will pay out-of-pocket in a plan year before your Medicare plan begins to cover 100% of the costs associated with your medical services. Original Medicare does not have an out-of-pocket maximum.

The costs you might have to pay out of your own pocket depend on the type of coverage you have. Some plans, like Medicare Supplement plans, help to limit those out-of-pocket costs.

Original Medicare (Parts A and B)

Original Medicare has no annual out-of-pocket maximum. You might be responsible for the following costs with Original Medicare:

  • Part A premium
  • Part A deductible ($1,484 in 2021) and coinsurance
  • Part B premium
  • Part B deductible ($203 in 2021) plus the coinsurance after the Part B deductible is met and Medicare has paid its share

Medicare Advantage (Part C) Plans

Medicare Advantage plans limit how much you'll pay out of pocket every year. After you reach the annual out-of-pocket maximum, your plan will pay all of your costs for Medicare-covered services for the rest of the period (usually a calendar year). Costs that don't apply to your annual out-of-pocket maximum include premiums, Part D prescription drugs, and extra benefits your plan might have that aren't covered by Original Medicare.

Medicare Supplement Insurance Plans (Medigap)

Medicare Supplement plans are designed to help limit out-of-pocket costs by helping to pay for some of the costs Original Medicare doesn't pay. There are Medigap plan options available with low to no copays. For example, the only out-of-pocket costs associated with Plan G would be your monthly premium and the annual Part B deductible ($198 in 2020). Medigap plans offer peace of mind with predictable out-of-pocket costs. Benefits and costs vary depending on the plan you choose.

Two Medigap plans do have a yearly out-of-pocket limit. These plans, Plans K and L, offer a lower monthly premium than other Medicare supplement plans because they pay a percentage of the coinsurance and you pay the rest. Once you meet the annual out-of-pocket limit, the plans pay 100% of covered services for the rest of the calendar year. Please note that the benefits, if covered, are covered 100% by most plans.

Medicare Prescription Drug (Part D) Plans

Part D plans don't have an out-of-pocket maximum. But, the amount you'll pay for your prescription drugs depends on the drug payment stage you're in.

  • Stage 1: Annual Deductible

    • Part D plans with a deductible: You pay full price for your prescription drugs until you reach the deductible amount.
    • Part D plans without a deductible: This does not apply. You start with Stage 2: Initial Coverage with the first prescription you fill.
  • Stage 2: Initial Coverage

    • You pay a copay or coinsurance. Your plan pays the rest.
    • You stay in the Initial Coverage stage until your total drug costs reach $4,430 in 2022.
  • Stage 3: Coverage Gap (also called "Donut Hole")

    • You pay:
      • 25% of the costs for brand name drugs
      • 25% of the costs for generic drugs
    • You stay in the Coverage Gap stage until your total out-of-pocket costs reach $7,050 in 2022.
  • Stage 4: Catastrophic Coverage

    • You pay a small copay or coinsurance amount.
    • You stay in the Catastrophic Coverage stage for the rest of the plan year.

Which are Original Medicare (Parts A and B) Costs?

What if I Need Help Paying Medicare Costs

You may be eligible for financial assistance to cover your health care expenses. There are several programs that help pay Medicare costs. Many people who could qualify never sign up, so be sure to apply if you think you might qualify. Don't hesitate to apply. Income and resource limits vary by program.


Enroll with RMHP

RMHP is here to help! Here’s how you can enroll in an RMHP Medicare Advantage or Dual Special Needs Plan.

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Choose a plan and enroll online.

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Call 866-568-3706 (TTY:711), and speak to a licensed agent.

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Find a meeting in your community.


Medicare Disclaimer

This page was last updated: 10/01/2021. Please call to confirm you have the most up to date information about our Medicare plans.


Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare. Other pharmacies, physicians, providers are available in our network. For a complete list of available plans please contact 1-800-MEDICARE, 24 hours a day/7 days a week or consult http://www.medicare.gov.   Every year, Medicare evaluates plans based on a 5-star rating system.  If you need help finding a network provider, please call 888-282-1420 or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org

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