Premiums. Co-Pays. Co-Insurance. Do You Understand These Medicare Terms?

Here’s some information to help you understand the terms used to describe your Medicare costs. (reposted from Medicare Made Clear)
Whether you get your Medicare benefits through Original Medicare or through a Medicare Advantage, you are likely to have some out-of-pocket costs. The key is to understand upfront what you will be charged for and how the amount you are charged is determined. With this information, you can start to estimate what you might pay out-of-pocket with different plans you might be considering during Medicare Open Enrollment.

Here is a brief explanation of the main ways that Medicare shares the cost of your care with you.

  • Premium – This is a fixed amount you may have to pay, usually monthly, to participate in a Medicare Advantage or other private Medicare health plan. If you are enrolled in Medicare Part B, you also pay a premium to Medicare. Part A is premium free for most people. Some Medicare Advantage plans do not have a premium.
  • Deductible – This is a fixed amount you must pay for your medical care before Medicare or other insurance pays. Deductibles apply during a calendar year, and the amount can vary among private Medicare plans of the same type. With Original Medicare, Part A and Part B each have a deductible. Some plans may not have a deductible.
  • Copayment – Also known as a copay, this is a fixed amount you pay for a service or product at the time you get it. With a standalone Medicare prescription drug plan (Part D), for example, you might pay a $10 or $20 copayment each time you fill or refill a prescription.
  • Coinsurance – This is what you pay when the total cost of a service or product you receive is split with your plan. It is a percentage. For example, Medicare Part B might pay 80% of the cost for a visit to your doctor, and you would pay 20%.

Both Original Medicare private Medicare plans use these cost-sharing methods. But each plan has its own terms and conditions, so it’s important to read the plan material carefully.

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