Summary of Medicare Benefits and Cost-Sharing for 2019

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 2019, You Will Pay a Monthly Premium of
0-29 quarters of Social Security credits $437
30–39 quarters of Social Security credits $240
40 or more quarters of Social Security credits $0
Inpatient Hospital Deductible $1,364
Inpatient Hospital Coinsurance $341 per day for days 61–90
$682 per day for days 91-150
Skilled Nursing Facility Coinsurance $170.50 per day for days 21-100
Service Provided Medicare Pays You Pay
Hospital Inpatient
Days 1-60 100% after deductible $1,364 deductible
Days 61-90 100% after copayment $341 per day copayment
60 Reserve Days1 100% after copayment $682 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 $170.50 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 $1,364
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 2019
  • Single: up to $85,000
  • Couple: up to $170,000
$135.502
  • Single: $85,001 to $107,000
  • Couple: $170,001 to $214,000
$189.60
  • Single: $107,001 to $133,500
  • Couple: $214,001 to $267,000
$270.90
  • Single: $133,501 to $160,000
  • Couple: $267,001 to $320,000
$352.20
  • Single: $160,001 and over
  • Couple: $320,001 and over
$433.40
Service Medicare Pays You Pay
Annual Deductible $185/yr.3
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 $1,364 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: $1,364 deductible
Days 61-90: $341 per day copayment
60 Reserve Days: $682 per day copayment
After 150 Days: 100% for each day
Outpatient 80% of approved amount 20% of approved amount

 

2 The standard Medicare Part B premium for 2019 is $135.50. An estimated 2 million Medicare beneficiaries (about 3.5%) will pay less than the standard premium, because the increase to their Social Security benefits will not be large enough to cover the full Part B premium increase. Beneficiaries with higher incomes will pay higher Part B premiums. Those who pay the standard premium include:

  • Newly eligible beneficiaries (whose Medicare becomes effective January 1, 2019 or later);
  • Beneficiaries who do not have their Part B premium deducted from their Social Security check, and
  • Beneficiaries who also qualify for full Medi-Cal benefits or a Medicare Savings Program (because Medi-Cal pays the Part B premium).

3 Beneficiaries in Medicare Advantage plans do not pay the Part B annual deductible. Medigap Plans C and F include the Part B annual deductible as a benefit.