Skip to Content (Press Enter)
Info

Members

What Does It All Cost

All Medicare plans have some level of cost-sharing. Here are some of the costs you might be responsible for paying.

Premium

A fixed, monthly amount you pay your insurer for your plan coverage.

Deductible

What you pay before your insurer begins to pay its share of the costs. Some part C plans charge an annual deductible for medical and/or prescription drug costs.

Copay

A defined amount you pay each time you receive care. Copays vary by services and benefits.

Coinsurance

A percentage you pay for medical services after you’ve met your deductible. Insurers set their own percentages.

Out of pocket maximum

Medicare Advantage plans include an annual limit on how much you pay for covered services. When you reach that limit, you don’t pay additional costs for covered services. Original Medicare doesn’t include this limit.

Part APart BPart CPart DMed Supp
PremiumNo premium if you or your spouse worked and paid Medicare taxes for at least 10 years.Vary depending on income.Vary by Plan. Some plans have no premiums.YesYes, varies by plan.
DeductiblePart A deductibles apply to each inpatient stay. YesVary by PlanVary by PlanSome Plans
CopayVary by service and length of careNoYesVary by PlanVary by Plan
CoinsuranceNoYesYesVary by PlanVary by Plan
Out of Pocket MaximumNoNoYesNoNo

Breaking Down Medicare Part D Cost Sharing for 2021

There are several stages of cost sharing with Part D plans. Most Medicare drug plans have a coverage gap, often referred to as the Medicare “donut hole.” In the coverage gap, there is a temporary limit on what the plan covers.

Breaking down Part D Cost Sharing

Part D Formularies and Your Costs

Part D plans have a drug list, or formulary, that shows all the brand-name and generic drugs it covers.

Many plans have a tiered formulary, where drugs are divided into groups called "tiers".

In general, the lower the tier, the lower the cost to you.

Generic drugs typically fall into Tier 1.

  • H4213_PFFS Website 2020
  • S5795_PDP Website 2020
  • H9699_HMO Website 2020
  • H4213_PFFS Website 2021
  • S5795_PDP Website 2021
  • H9699_HMO Website 2021
  • H3554_PPO Website 2021
  • H6158_HMO Website 2021

Last updated 10/01/2020