In 2023 the costs that Medicare beneficiaries will be facing are:
Part A covers Inpatient care in a hospital / Skilled nursing facility care / Nursing home care / Hospice Care
The Medicare costs in 2023 for Part A are
- $0.00 for those who qualify. This anyone who has paid at least 10 years of FICA taxes through employment. Those who have been married to someone for at least 10 years also qualify, even if they have never worked.
- $280.00 a month for those who only partially qualify for premium fee Part A.
- $509.00 a month for those who do not qualify for premium free Part A.
$1,600 per qualifying incident (occurrence).
How the Part A Deductible works:
Person A, who is covered by Medicare Part A, is admitted for a medical need as an inpatient, there is a deductible for this occurrence. If Person A is again admitted for a different occurrence, then there will be another deductible that must be paid.
Now, if Person while admitted as an in-patient for a medical need experiences a new occurrence or health condition that requires yet another and different service they will be assessed another Part A Deductible.
Inpatient Care – Hospital Stays:
Inpatient care covers services such as the room, meals, nursing staff, medications and other hospital services and supplies.
The costs are broken into a number of days which correspond with a particular occurrence, which are:
- Days 1-60: $0.00.
- Days 61-90: $400.00 per day.
- Days 91 and beyond: $800.00 per day, up to 60 days.
Skilled Nursing covers care that must be received in a skilled nursing facility. A doctor must prescribe the care and it can only be a short period of time.
The costs, like Inpatient Care, are broken into days and they are:
- Days 1 – 20: $0.00.
- Days 21 – 100: $200.00 per day.
- Days 101 and beyond: All costs.
Note: With certain Supplemental Plans (Medigap) the ability to cover all costs of Part A can be achieved as well as extending the number of Hospital Stays to 365 days per year.
Nursing Home Care:
Covers services like medically necessary part-time or intermittent skilled nursing care, physical and occupational therapy and social services.
To qualify a doctor must prescribe the care.
There are no costs with Nursing Home Care other than meeting the Part B Deductible and a 20% charge of the Medicare-Approved Amount for Medicare-covered medical equipment.
Hospice care is for only those who have been diagnosed with less than 6 months. The only costs are a co-pay for certain medications that manage pain.
Part B covers (according to the Centers for Medicare Services (CMS):
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
The Medicare costs in 2023 for Part B are:
Premium: $164.90 a month.
Deductible: $226.00 per year
Excess charge: 15%. This charge is for healthcare providers who do not participate in the Medicare program.
Note: Certain Supplemental Plans (Medigap) can cover the Part A Deductible and the Part B Excess Charge.
IRMAA applies to people with higher incomes who are enrolled in Part B and/or covered under a Medicare Part D Prescription Drug Plan. For those who enter Medicare’s IRMAA there will be a surcharge on top of their monthly Medicare Part B and Part D premiums.
2023 IRMAA Brackets:
|Individual MAGI||Couples MAGI||Part B||Part D|
|< $97,000||< $194,000||$164.90||Premium (varies)|
|$97,000 to $123,000||$194,000 to $246,000||$230.80||Premium + $12.20|
|$123,000 to $153,000||$246,000 to $306,000||$329.70||Premium + $31.50|
|$153,000 to $183,000||$306,000 to $366,000||$428.60||Premium + $50.70|
|$183,000 to $500,000||$366,000 to $750,000||$527.50||Premium + $70.00|
|> $500,000||> $750,000||$560.50||Premium + $76.40|
Note: Social Security benefits will automatically pay these IRMAA surcharges. A Medicare beneficiary will receive a bill if they are receiving Social Security.
Part D provides coverage for medications. Private health insurance companies administer this coverage while CMS regulates the private health insurers.
All costs are set by the private health insurers and they do vary by company and state.
The Part D Medicare costs in 2023 are:
$48.43 per month.
- This premium is based on a national average and is combination of plans that also include a deductible. The price of the premiums varies by residency, medications within the plan and by the insurance company that administers the plan.
$465 a year on a national average.
- Not all plans have a deductible. When enrolling into a Part D plan there is always an option to select a plan that comes with a deductible or not.
Co-Pays and Co-Insurance:
Private health insurance companies determine the co-pays and co-insurance for the medications that the plans are covering.
Supplemental Coverage covers the gaps within Medicare Parts A and Part B. These plans can extend coverage as well as cover the Part A Deductible as well as the co-pays that are included in Parts A and B.
Private insurers administer these plans and the private health insurers are regulated by CMS.
Medigap Plans have different types (A – N) that will have varying types of coverage. Plan G, in 2023, is the most robust plan that is available to all new Medicare enrollees.
The Supplemental Medicare costs in 2023 are:
$187.83 a month on a national average.
- Premiums vary by residency, age and gender as well as the private insurer who administers the plan. This premium is for Medigap Plan G policy which is blended to include non-tobacco and tobacco users.
MA Plans, by law, must provide the exact same coverage that Original Medicare (Parts A & B) provides, but still can offer a wide variety of other types of coverage as well.
Private health insurance companies administer these plans and CMS oversees them.
MA Plans Medicare Costs in 2023:
All costs vary upon the type of plan, the private health insurer and even residency.
On a national average
- HMO: $19.33 a month. Premiums can range from $0.00 a month to $296.00 a month.
- PPO: $26.91 a month. Premiums can range from $0.00 a month to $301.00 a month.
- Regional PPO: $65.14 a month. Premiums can range from $0.00 a month to $198.00 a month.
On national average:
- HMO: $307.50 annually.
- PPO: $278.34 annually.
- Regional PPO: $297.85 annually.
Medicare Advantage Plans may also include a maximum out-of-pocket in network cost (MOOP) for enrollees who utilize coverage in a given year.
On a national average the MOOP per type of MA Plan is:
- HMO: $5,071 annually.
- PPO: $5,729 annually.
- Regional PPO: $6,826 annually.
Medicare is one of the best possible types of health insurance a person can have. With proper coverage and by utilizing the program prudently the only costs can be just the premiums for coverage and the Part B Deductible.
You actually can plan for health coverage in retirement.