// 2021 Benefits, Premiums and Costs

Medicare Parts A, B, C & D

The follow information details benefit coverage, premiums and out-of-pocket costs for Medicare Parts A, B, C & D and was obtained from Medicare.gov.

  • Part A Hospital
  • Part B Medical
  • Part C (Advantage Plans)
Medicare Premiums Beneficiary Pays for Part A Monthly Premium 

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

  • $471/month for those with fewer than 30 quarters of Medicare-covered employment
  • $259/month for those with 30-39 quarters of Medicare-covered employment
Beneficiary Pays for Skilled Nursing Facility Stay 
  • $0 for the first 20 days of each benefit period
  • $185.50 per day for days 21–100 of each benefit period
  • All costs for each day after day 100 of the benefit period
Beneficiary Pays for Hospital Stay
  • $1,484 deductible per benefit period
  • $0 for the first 60 days of each benefit period
  • $371 per day for days 61–90 of each benefit period
  • $742 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
Medicare Premiums Beneficiary Pays for Part B Monthly Premium 

Most people pay the standard Part B premium amount which is $148.50 in 2021

  • If your income was more than $88,000 ($176,000 filing joint) you’ll pay $207.90
  • If your income was more than $111,000 ($222,000 filing joint) you’ll pay $297.00
  • If your income was more than $138,000 ($276,000 filing joint) you’ll pay $386.10
  • If your income was more than $165,000 ($330,000 filing joint) you’ll pay $475.20
  • If your income was more than $500,000 ($750,000 filing joint) you’ll pay $504.90
Beneficiary Pays for Part B Services 
  • $203.00 deductible per benefit period
  • 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, outpatient mental health services, certain home health services, and durable medical equipment
Medicare Advantage plans combine Part A and B into one plan.

Offered as a alternative to original Medicare, these plans are sold and serviced by Medicare-approved health insurance companies as an alternative option to your Original Medicare coverage. Premiums and out-of-pocket costs may vary depending on your plan, however most people pay as low as $0 to $25 in addition to your monthly Medicare Part B premium (see above). To ensure you find a plan that fits your specific healthcare needs and budget, please contact our licensed Medicare agent for professional assistance.

For 2021 Medicare Part D Costs, most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (Part C) or Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.

-If your income was more than $88,000 ($176,000 filing joint) you’ll pay $12.30 + your plan premium

-If your income was more than $111,000 ($222,000 filing joint) you’ll pay $31.80 + your plan premium

-If your income was more than $138,000 ($276,000 filing joint) you’ll pay $12.30 + your plan premium

-If your income was more than $165,000 ($330,000 filing joint) you’ll pay $12.30 + your plan premium

-If your income was more than $500,000 ($750,000 filing joint) you’ll pay $12.30 + your plan premium

Deductibles vary between Medicare drug plans. Some Medicare drug plans don’t have a deductible.

-No Medicare drug plan may have a deductible more than $445 in 2021.

Once your deductible is met, you’ll pay a coinsurance (copay) for prescription drugs. Note that the amount of your copay may change during the benefit period, if the drug price fluctuates.

-Initial coverage limit is $4,130 (plan pays 75% – you pay 25%)

-Once you and your plan pay this amount, you’ll continue to pay 25% of the cost of your prescriptions drugs until you reach your threshold

-Annual out-of-pocked threshold is $6,550

Once you and your plan have spent $4,130 on covered drugs in 2021, you’re in the coverage gap (a temporary limit on what the plan covers). Even though you’ll only pay 25% for both brand name and generic drugs at this point, almost the full price of the drug (except for what the plan pays) will count as out-of-pocket costs to help you get out of the coverage gap.

-The manufacturer pays 70% of drug costs
-The plan pays 5% of drug costs
-You pay 25% of drug costs
-The plan also pays 75% of a dispensing fee, you pay 25% of the dispensing fee

Once you reach your threshold ($6,550), you are out of the coverage gap (donut hole) and you’ll automatically get catastrophic coverage. This assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

-You’ll pay 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year.
-Your plan pays the rest