What do Medicare Parts cover and cost in 2021?
There are 4 parts of Medicare: Part A, Part B, Part C, and Part D.
- Part A covers inpatient hospital services.
- Part B covers outpatient medical services.
- Part C is Medicare Advantage plan offered by private companies approved by Medicare.
- Part D provides prescription drug coverage to lower the cost you pay for medications.
Estimated reading time: 9 minutes
Before you receive inpatient hospital benefits, you must first pay Part A deductible of $1484 in 2021. However, you can avoid paying this cost by having a Medicare Supplement plan.
What does Medicare Part A cover and cost in 2021?
According to Medicare.gov, Part A covers the following:
- Inpatient hospital care
- Skilled Nursing Facility care
- Long-term Care Hospitals
Inpatient Hospitals Coverage and Cost in 2021
The first 60 days of inpatient care is covered by Medicare Part A. In other words, you pay $0 coinsurance for each 60 day benefit period. For example, you can be a hospital inpatient multiple times per year and each hospital stay will cost you nothing so long as each stay is 60 days or less. However, hospital stays between 61 days and 90 days will cost you $371 coinsurance per day in 2021.
Skilled Nursing Facility Coverage and Cost in 2021
Medicare Part A also covers 20 days of care in a Skilled Nursing Facility (SNF). Specifically, you pay $0 coinsurance for each 20 day benefit period. Some of the benefits of SNF include physical therapy, meals, and dietary counseling. Therefore, you can get short-term skilled nursing care multiple times per year for no cost so long as each stay is 20 days or less. However, SNF stays between 21 days and 100 days will cost you $185.50 per day in 2021.
Long-term Care Hospital Coverage and Cost in 2021
Medicare Part A covers the first 60 days in a Long-term Care Hospital (LTCH). In particular, the cost of LTCH is $0 for each 60 day benefit period under the following conditions.
- You are transferred to a LTCH directly from an acute care hospital.
- You are admitted to a LTCH within 60 days of being discharged from a hospital.
If the above conditions do not apply, then you must pay Part A $1484 deductible in 2021 before Medicare will pay anything. Furthermore, LTCH stays from 61 days to 90 days will cost you $371 coinsurance per day in 2021.
What does Medicare Part B cover and Cost in 2021?
Medicare Part B covers the following services:
- Medical outpatient services for stays at any hospital or medical facility for less than 24 hours. For example, a stay that occurs overnight but for less than 24 hours is outpatient service.
- Preventive services to prevent illness such as seasonal flu-shot and annual wellness visits.
Medicare Outpatient Coverage and Cost in 2021
Original Medicare covers 80% of medically necessary services and supplies. These Part B medical services include:
- Ambulance Service – transportation to a medical facility.
- Doctor Visits – anytime to see your primary doctor or specialist.
- Mental Health – psychotherapy and counseling to treat conditions such as anxiety and depression.
- Durable Medical Equipment – devices that assist with your medical conditions. For example, blood sugar monitors, oxygen equipment, and wheelchairs.
Before Medicare pays for these medical services and supplies, you must first pay Part B deductible of $203 in 2021. Furthermore, you are responsible to pay the 20% that Medicare does not cover. However, Medicare Supplement Plan C and Plan F pay Part B deductible and your 20% coinsurance.
Medicare Preventive Coverage and Cost
Medicare preventive services cover screening tests that help detect health conditions at early stages when treatment is most effective. In the tables below, we list 31 preventive tests covered by Medicare Part B.
In the above tables, 71% of these screening tests are free after you pay the $203 Part B deductible. Furthermore, 19% of tests require payment of Part B deductible and 20% coinsurance. Finally, 10% of tests you pay absolutely nothing: neither Part B deductible nor 20% coinsurance. If you qualify, you many pay nothing for the following preventive screening tests:
- Nutrition Therapy Service – you pay nothing if you have diabetes or kidney disease.
- “Welcome to Medicare” preventive visit – you pay nothing as long as the doctor does not perform additional tests or services.
- Yearly Wellness Visit – available every 12 months as long as the doctor does not perform additional tests or services.
To receive Part B coverage you need to pay a monthly premium. In 2021, the standard premium for Part B is $148.50.
What does Medicare Part C cover and cost in 2021?
Medicare Part C is an alternative to Original Medicare and covers Part A (Hospital Insurance) and Part B (Medical Insurance). Part C is also known as Medicare Advantage (MA) Plan.
Medicare Advantage (MA) Coverage
MA plans often include Medicare Part D prescription drug coverage. Moreover, many MA plans include extra benefits not covered by Original Medicare. For example, MA plans may include dental, vision, and hearing. Some MA plans even include gym memberships such as Silver Sneakers! MA plans are offered through a network of healthcare providers HMO or PPO.
Medicare Advantage (MA) Costs
To enroll in Medicare Advantage Plan (Part C) you must first be enrolled in Part A and Part B. Most Medicare beneficiaries pay no premium for Part A. However, you will have to pay Part B monthly premiums. In 2021, the standard premium for Part B is $148.50. Furthermore, you will need to pay a monthly Part C premium. According to The Kaiser Family Foundation, the average Medicare Advantage Plan premium is $36 in 2020.
When you add standard Part B and average MA premiums, the total monthly cost is $180.66 in 2020. Conversely, Original Medicare Part B and Part D premiums may only cost on average $177.34 in 2020. However, you may be thrilled to get a gym membership for only a few extra dollars per month!
You can choose a lower premium MA plan. As a result, you may be excited to pay less every month. However, some MA plans will have higher deductibles, copays, and larger out-of-pocket limits. Consequently, the cost to use your health insurance may be much higher. You may be able to avoid these excessive costs by choosing an MA premium of $40 or more.
What does Medicare Part D cover and cost in 2021?
Part D saves you money on prescription drugs. Specifically, it reduces your cost for brand-name and generic drugs. For example, rather than paying the full retail price for medications, you only pay small copayments with Part D. To join a Part D drug plan, you must be enrolled in certain parts of Medicare.
How to Join a Drug Plan
You must have either Part A or Part B to join a stand-alone Part D drug plan with Original Medicare. However, you must have both Part A and Part B to join a Medicare Advantage plan.
Part D Costs for Original Medicare and MA Plans
To enroll in Part D with Original Medicare you need to have either Part A or Part B. However, most people have both Part A and Part B coverage. Since private health insurance companies such as Aetna and Mutual of Omaha provide drug coverage, the price you pay will vary.
Part D drug costs in 2021
All Part D drug plans have a monthly Part D premium. This amount will depend on the income reported on your 2019 tax return. Some Part D plans have an annual deductible which can not be more than $445 in 2021. However, other drug plans may have little or no deductible.
After the out-of-pocket deductible, you pay either a copay or coinsurance for each prescription drug. For example, you pay less for drugs in tier 1 and more for drug in tier 2. Discover the differences in Medicare Part D tier costs. Furthermore, after you and your drug plan spend a certain amount, you enter a coverage gap called the donut hole.
Donut Hole Costs in 2021
In 2021, you enter the donut hole after your plan spends $4,130. Then you pay no more than 25% coinsurance for the plan’s covered brand-name and generic prescription drugs. After total out-of-pocket drug costs are $6,550 in 2021, you exit the donut hole. Learn more about the 4 stages of drug coverage and costs in 2021.
Want More Help with Medicare Parts?
You can speak with a licensed agent at 1-855-368-4717 and get more help with the 4 parts of Medicare: A, B, C, and D. Our team is very experienced at explaining Medicare parts and how they work.
Last Updated on May 19, 2021 by Brian Kondas