While the Medicare Part B Deductible is only $198 annually, it is not the only cost to consider when it comes to Medicare Part B coverage. First, a quick review of what Medicare Part B covers.
Medicare Part B Coverage
Medicare Part B covers the doctor part of benefits, whereas Part A covers the hospital parts. Medicare Part B coverage includes :
- Medically necessary services
- Preventative services
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Partial hospitalization
- Limited outpatient prescription drugs
Differences between deductibles, premiums, and co-insurance:
Part B Premium Cost
The overwhelming majority of Americans pay an annual premium of $144.60 for Medicare Part B Coverage. This means that whether or not you use your coverage or not, you will be automatically billed a premium, much like a subscription cost.
Part B Deductible
The Part B premium is $198 for 2020. Different than a premium, a deductible is not automatically billed. The Medicare Part B deductible would only be paid when you need to use benefits from Part B. So, for instance if you haven’t needed to use any coverage under Part B until 9 months after you pay your annual premium, then you would only pay your deductible at the time coverage is needed. Once your deductible is met, any other Part B Medicare expenses will be covered without any further deductible expense.
Part B Co-insurance
Different than Part A, Part B has a 20% co-insurance. This means that Medicare will pay 80% of any benefits eligible under Part B. The Medicare beneficiary is responsible for the other 20%.
For some routine procedures, this may not be a heavy financial burden. However, the 20% co-insurance impact of a surgical procedures like a knee replacement can quickly trigger financial hardship, raising the importance of personal risk awareness.
The standard price for a knee replacement surgery in the U.S. is $57,000. This is no longer considered an inpatient procedure which would be 100% covered under Part A. Instead, this would be covered under Part B and bring a 20% co-insurance cost to a Medicare beneficiary of $11,400.
So, under Medicare Part B, associated costs of coverage include the Medicare Part B deductible, premium, and co-insurance.
How to Afford the Gaps of Medicare Part B
In 2016, Kaiser Family Foundation reported that 8 out of 10 Medicare beneficiaries carried additional insurance to mitigate the financial risks that come with “original Medicare”.
Additional insurance coverage occurs either with a Medicare Supplement plan (also known as MediGap) or a Medicare Advantage plan. Since each Medicare beneficiary has unique and different needs, we do a professional review of each person’s situation individually: medical needs, location, doctor network, budget and lifestyle, just to name a few.
We help Medicare beneficiaries all over southern California evaluate coverage options that are just right for their specific needs.
If you would like a free consultation on how we might be able to help you, give us a call at (714) 834-1322 or tell us more about your situation using our online form.