2021 Medicare Coverage Costs

In this article we will cover this years out-of-pocket costs for original Medicare, Medicare Advantage, MediGap and Medicare Part D Prescription Drug Coverage (PDP) 

Medicare Costs: Overview 

• 2021 Medicare Part A Premiums and Deductibles
• 2021 Medicare Part B Premiums and Deductibles
• 2021 Medigap Premiums 
• 2021 Medicare Advantage Premiums 
• 2021 Medicare Part D Premiums, Deductibles and out of pocket costs
• 2021 Medicare Extra Help copays

 Choosing the right Medicare plan option is a complicated decision. There are many things to consider before you choose which plan fits your needs and your budget.  This is a quick overview of what costs will be for 2021. Keep in mind that these benefits change year to year.

*Important – Individuals enrolled into Medicare Advantage plans are still responsible to pay their monthly Medicare Part B premiums. Additionally, copays, out-of-pocket maximums, and cost sharing amounts may change for individuals enrolled in Medicare Advantage plans. These costs below will apply to Original Medicare recipients only.

 Medicare Part A (Hospital) Coverage

2021 Medicare Part A Premiums

• No monthly premium for beneficiaries with sufficient time paid into Medicare payroll tax.
• $263 a month, for individuals who only paid into Medicare Payroll tax between 7.5 and 10 years.
• $478 a month, for individuals who paid less than 7.5 years into Medicare Payroll tax.

2021 Part A Deductible

• $1,452 deductible
• Will cover up to 60 days in the hospital
• Deductible is cost per benefit period not on annual costs. A single benefit period lasts until 60 days after a person has been released from the hospital. If a person goes back in then they will have to repay the Part A deductible, even if it is in the same year.
• If you have a Medigap or Medicare Supplemental plan it will pay some or all of your Medicare deductible depending on which plan you have

2021 Part A Coinsurance

• $363 per inpatient day for days 61-90 in the hospital during a single benefit period.
• $726 per inpatient day for day 91 and beyond during the benefit period (These are limited to 60 days for a lifetime).
• Medicare Part A will pay 100% of the cost of a skilled nursing facility for the first 20 days after a three-night inpatient hospital stay. After the first 20 days in a skilled nursing facility the 2021 projected daily cost is projected to be $181.50 per day for days 21-100. After that Medicare will no longer cover skilled nursing facilities costs.

2021 Medicare Part B Premiums

• The Part B premium for most Medicare Beneficiaries in 2021 is $148.50 per month.
• For people with higher income they may pay a higher monthly Medicare Part B Premium. If somebody has a single income of $87,000 or $174,000 for couples their Medicare Part B premium can be between $245 a month to $368 a month.
• For individuals who enrolled into Medicare Part B later than when first eligible for Medicare there may be a higher premium due to a late enrollment penalty.

2021 Medicare Part B Deductible

•  If somebody received any Medicare Part B covered services, they will be responsible for the Medicare Part B deductible before the plan will cover any portion of the services received.
• The deductible for 2021 has not yet been released but for 2020 it was $198 annually.
• After the Medicare Part B deductible is paid then Medicare will start paying 80% of the cost of covered services. The beneficiary is responsible for 20% but with no limit.

Medigap / Medicare Supplement

Premiums for Medigap:

• The Medigap Plan G (which is separate from Medicare part A , B, C, or D) is the most comprehensive plan available through Medicare Supplement. But it does not include Medicare Part B deductibles in the coverage. 
• The average Medigap Plan G plan costs $150 a month in 2020.
• There are other standardized plans available through Medicare Supplement that will have varied premiums and coverage costs.

Out of Pocket costs for Medigap

• These costs will largely depend on which Medigap plan you select.

Medicare Advantage / Medicare Part C / MAPD

2021 Premiums for Medicare Advantage

• 2021 Medicare Part B premium is projected to be $153.30 a month + Medicare Advantage premium, if there is any.
• In 2020 the average Medicare Advantage premium was $36 a month. But many Medicare Advantage plans have $0 monthly premiums. The premiums for 2021 have not yet been released by CMS.

2021 Medicare Advantage Maximum out of pocket

• $7,550 is the maximum allowable out of pocket for Medicare Advantage plans, but many Medicare advantage plans still set their maximum out of pocket cost at a much lower rate. In 2020 the average Maximum out of pocket costs (not including medication costs) is $6,700.

Medicare Part D prescription Drug Coverage

2020 Medicare Part D Premiums

• 2021 expected Medicare Part D prescription drug coverage premiums are expected to be on average $30.50 a month. There are plans that have higher benefits and they may cost more. Additionally plans with lower benefits may have a monthly premium as low as $13 a month.
• For high individual earners, the premium for Medicare Part D may be higher ( if your income is above ($87,000 for an individual and $174,000 for a couple).

Part D deductible

•  2021 Maximum Deductible allowable for Medicare Part D is $435 annually.

Out-of-pocket costs after deductible for part D

• Cannot exceed 25 percent of the cost of prescriptions.
• Once a beneficiary reaches $6,550 in cost for medications, they will enter the Catastrophic stage which will lower their cost sharing to either 5% of the medication cost or $3.70 for generics or $9.20 for brand name drugs, whichever is higher.
• Part D plans are required to include many insulins for no more than $35 a month in 2021.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.