Summary of Medicare Benefits and Cost-Sharing for 2016

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The chart below is a comprehensive list of Medicare Part A and B costs, including premiums, deductibles and coinsurance. Medicare supplemental insurance, known as Medigap, can help cover some of the gaps in coverage and pay for part or all of Medicare's coinsurance and deductibles, depending on the policy. Some Medicare Advantage (MA) plans may also help cover these costs. See Medigap: Medicare Supplemental Insurance and Medicare Advantage for more information.

Comprehensive Part A (Hospital Insurance) Costs

Part A – Hospital Insurance Premiums, Deductibles & Coinsurance
If You Have In 2016, You Will Pay a Monthly Premium of
0-29 quarters of Social Security credits $411
30–39 quarters of Social Security credits $226
40 or more quarters of Social Security credits $0
Inpatient Hospital Deductible $1,288
Inpatient Hospital Coinsurance $322 per day for days 61–90 
$644 per day for days 91-150
Skilled Nursing Facility Coinsurance $161 per day for days 21-100
Service Provided Medicare Pays You Pay
Hospital Inpatient
Days 1-60 100% after deductible $1,288 deductible
Days 61-90 100% after copayment $322 per day copayment
60 Reserve Days1 100% after copayment $644 per day copayment
After 150 Days 0% 100% for each day
Psychiatric Hospital Same as hospital inpatient (see above) with a 190-day lifetime limit 100% after 190 days
Skilled Nursing Facility (SNF)
(if daily skilled care is needed after a 3-day hospital stay)
Days 1-20 100% 0%
Days 21-100 100% after copayment $161 per day copayment
After 100 Days 0% 100%
Home Health Care 100% minus 20% of covered medical equipment 20% of Medicare-approved amount for medical equipment
Hospice Care 100% minus $5 per prescription; 95% of Medicare-approved payment for respite care per day Copayment of $5 per prescription; 5% of Medicare-approved payment for respite care per day, not to exceed $1,288
Blood (received during hospital or SNF stay) 100% after first 3 pints of blood First 3 pints of blood each year

1 Each of the 60 reserve days may be used only once during an individual's lifetime.

Comprehensive Part B (Medical Insurance) Costs

Part B – Medical Insurance Deductibles & Premiums
Your Annual Income Your Monthly Premium For 2016*
  • Single: up to $85,000
  • Couple: up to $170,000
$121.802
  • Single: $85,001 to $107,000
  • Couple: $170,001 to $214,000
$170.50
  • Single: $107,001 to $160,000
  • Couple: $214,001 to $320,000
$243.60
  • Single: $160,001 to $213,000
  • Couple: $320,001 to $426,000
$316.70
  • Single: $213,001 and over
  • Couple: $426,001 and over
$389.80
Service Medicare Pays You Pay
Annual Deductible $166/yr.
Physician Costs 80% of approved amount 20% of Medicare-approved amount, plus up to an additional 15% of the approved amount if the doctor or supplier does not accept assignment
Outpatient Hospital Care 80% of approved amount $1,288 maximum
Clinical Lab Services Approved amount $0
Medical Equipment/Supplies 80% of approved amount All other costs
Certain Preventive Services (depending on the service, some are covered at certain intervals, such as once per year) 80% or 100% 20% of approved amount or $0, depending on the service
Mental Health Services
Partial Hospitalization
Days 1-60: 100% after deductible
Days 61-90: 100% after copayment
60 Reserve Days1: 100% after copayment
After 150 Days: 0%
Days 1-60: $1,288 deductible
Days 61-90: $322 per day copayment
60 Reserve Days: $644 per day copayment 
After 150 Days: 100% for each day
Outpatient 80% of approved amount 20% of approved amount

* Premium is per person
1 Each of the 60 reserve days may be used only once during an individual's lifetime.
2 Approximately 70% of Medicare beneficiaries are “held harmless” and continue to pay the same premium amount they paid in 2015 which is $104.90. The other 30% pay the 2016 standard premium amount of $121.80 (or higher depending on their income). These beneficiaries include those who are new to Medicare in 2016, those with higher incomes, and those who do not have the Part B premium deducted from their Social Security check, which includes beneficiaries who also qualify for Medi-Cal or a Medicare Savings Program. Medi-Cal pays the Part B premium for this last group.

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Updated Dec 10, 2015

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