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Medicare 2015 & 2016 costs at a glance

Listed below are basic costs for people with Medicare. If you want to see and compare costs for specific health care plans, visit the Medicare Plan Finder.

If you want specific cost information (like whether you've met your deductible, how much you'll pay for an item or service you got, or the status of a claim), visit MyMedicare.gov

Find out if Medicare covers a specific test, item or service that's not listed under the detailed Medicare cost information section of this page.

2015 & 2016 Costs at a Glance
Part A premium Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $407 each month ($411 in 2016). Calculate my premium.
Part A hospital inpatient deductible and coinsurance

You pay:

  • $1,260 deductible for each benefit period ($1,288 in 2016)
  • Days 1-60: $0 coinsurance for each benefit period ($0 in 2016)
  • Days 61-90: $315 coinsurance per day of each benefit period ($322 in 2016)
  • Days 91 and beyond: $630 coinsurance ($644 in 2016) per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs (all costs in 2016)
Part B premium Most people pay $104.90 each month ($104.90 in 2016).
Part B deductible and coinsurance $147 per year ($166 in 2016). After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
Part C premium The Part C monthly premium varies by plan. Compare costs for specific Part C plans.
Part D premium The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.

Detailed Medicare cost information for 2015 & 2016

Part A costs if you have Original Medicare

Note

All Medicare Advantage Plans must cover these services. If you're in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those in Original Medicare. Review the "Evidence of Coverage" from your plan.

  • Home health care

  • Hospice care

    • $0 for hospice care.
    • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it's covered under Part D.
    • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
    • Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • Hospital inpatient stay

    • $1,260 deductible for each benefit period ($1,288 in 2016).
    • Days 1–60: $0 coinsurance for each benefit period ($0 in 2016).
    • Days 61–90: $315 coinsurance per day of each benefit period ($322 in 2016).
    • Days 91 and beyond: $630 coinsurance ($644 in 2016) per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond <a href="https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#1347" name="1347" title=" <p>In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.</p> " class="glossary">lifetime reserve days: all costs (all costs in 2016).
    Note

    You pay for private-duty nursing, a television, or a phone in your room. You pay for a private room unless it's medically necessary.

  • Mental health inpatient stay

    • $1,260 deductible for each benefit period ($1,288 in 2016).
    • Days 1–60: $0 coinsurance per day of each benefit period ($0 in 2016).
    • Days 61–90: $315 coinsurance per day of each benefit period ($322 in 2016).
    • Days 91 and beyond: $630 coinsurance ($644 in 2016) per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond <a href="https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#1347" name="1347" title=" <p>In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.</p> " class="glossary">lifetime reserve days: all costs (all costs in 2016).
    • 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you're a hospital inpatient.
    Note

    There's no limit to the number of benefit periods you can have when you get mental health care in a general hospital. You can also have multiple benefit periods when you get care in a psychiatric hospital. Remember, there's a lifetime limit of 190 days.

  • Skilled nursing facility stay

    • Days 1–20: $0 for each benefit period.
    • Days 21–100: $157.50 coinsurance per day of each benefit period ($161 in 2016).
    • Days 101 and beyond: all costs.
  • Monthly premium:

    2015

    In 2015, most people pay the Part B premium of $104.90 each month.

    However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.
If your yearly income in 2013 (for what you pay in 2015) was You pay (in 2015)
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $104.90
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $146.90
above $107,000 up to $160,000 above $214,000 up to $320,000 Not applicable $209.80
above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 and up to $129,000 $272.70
above $214,000 above $428,000 above $129,000 $335.70

2016

In 2016, the standard Part B premium amount will be $121.80 (or higher depending on your income). However, most people who get Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015. This is because there wasn't a cost-of-living increase for 2016 Social Security benefits. You'll pay a different premium amount in 2016 if: 

  • You enroll in Part B for the first time in 2016.
  • You don't get Social Security benefits.
  • You're directly billed for your Part B premiums.
  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $121.80.)
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

If you're in 1 of these 5 groups, here's what you'll pay:

If your yearly income in 2014 (for what you pay in 2016) was You pay (in 2016)
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $121.80
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $170.50
above $107,000 up to $160,000 above $214,000 up to $320,000 Not applicable $243.60
above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 and up to $129,000 $316.70
above $214,000 above $428,000 above $129,000 $389.80
Get more information about your Part B premium from Social Security.
  • Late enrollment penalty:

In  most cases, if you don't sign up for Part B when you're first eligible, you'll have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year.

Learn more about the Part B late enrollment penalty.

Part B costs if you have Original Medicare

Note

All Medicare Advantage Plans must cover these services. If you're in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those in Original Medicare. Review the "Evidence of Coverage" from your plan.

  • Part B annual deductible:

    You pay $147 per year for your Part B deductible ($166 in 2016). After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

  • Clinical laboratory services:

 You pay $0 for Medicare-approved services.

 You pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

Note

In 2015 and 2016, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits. 

  • Outpatient mental health services

    • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
    • 20% of the Medicare-approved amount for visits to a doctor or other health care provider to diagnose or treat your condition. The Part B deductible applies.
    • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital. This amount will vary depending on the service provided, but will be between 20-40% of the Medicare-approved amount.
  • Partial hospitalization mental health services:

You pay a percentage of the Medicare-approved amount for each service you get from a doctor or certain other qualified mental health professionals if your health care professional accepts assignment. You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B deductible applies.

  • Outpatient hospital services

    • You generally pay 20% of the Medicare-approved amount for the doctor or other health care provider's services, and the Part B deductible applies.
    • For all other services, you also generally pay a copayment for each service you get in an outpatient hospital setting. You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor's office.
    • For some screenings and preventive services, coinsurance, copayments, and the Part B deductible don't apply (so you pay nothing).
  • Monthly premium:

 The Part C monthly premium varies by plan.

  • Deductibles, copayments, & coinsurance:

The amount you pay for Part C deductibles, copayments, and/or coinsurance varies by plan. Look for specific Part C plan costs, and then call the plans you're interested in to get more details.

Posted 8:11 AM  View Comments

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