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How Much Do Medicare Costs Vary among Medicare Providers?


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Can Medicare costs be different from one Medicare provider to the next? The truth is that most Medicare costs are standardized. There is some cost variation when it comes to some types of Medicare coverage.

Medicare costs under Part A and Part B

The Medicare program is available to most Americans age 65 and older as well as younger individuals who have disabilities. There are several parts to Medicare. Medicare Part A and Part B make up “Original Medicare.” The federal government sets rules about Original Medicare costs.

  • Medicare Part A helps to pay covered services performed by Medicare providers such as hospitals, skilled nursing facilities, hospice care, and some home health agencies. If you have Medicare Part A, your Medicare costs may include deductibles and coinsurance for covered services. While hospitals and other Medicare providers might charge different amounts for the same services, as long as the provider accepts Medicare assignment, your Medicare costs will be limited to the standard deductible or coinsurance based on Medicare’s approved amount.

 

  • Medicare Part B helps to pay covered Medicare providers’ services and outpatient treatments and diagnostic tests, such as x-rays and lab work. Your Medicare costs for these services generally include an annual Part B deductible and usually 20% of the Medicare-approved amount. As long as you receive care from a doctor who accepts Medicare assignment, you won’t be charged more than your standard Medicare cost-sharing amount (deductible and/or coinsurance).

 

Medicare costs under Medicare Advantage

Medicare Part C refers to Medicare Advantage, an alternative way of receiving Medicare Part A, Part B, and often Part D (prescription drug) benefits. Offered by private insurance companies approved by Medicare, Medicare Advantage plans offer at least the same level of coverage as Medicare Part A and Part B.

Often Medicare Advantage plans include more coverage than the government-run Original Medicare program offers. If you enroll in a Medicare Advantage plan, your Medicare costs will depend partly on the specific benefits offered by the plan you choose. But Medicare Advantage plans are not allowed to charge more than the government allows.

Some Medicare Advantage plans have an annual deductible; some do not. Similarly Medicare Advantage plans might charge coinsurance and/or copayments for specified services, which can vary by plan. But every Medicare Advantage plans has a maximum out-of-pocket limit (which can vary somewhat by plan) that places a cap on your Medicare costs for covered services during a benefit year. After you meet this cap, your Medicare Advantage plan typically pays 100% for covered hospital and medical services.

One way that some Medicare Advantage plans help control Medicare costs is by contracting with Medicare providers. With these Medicare Advantage plans, you can generally save money by getting care from the plan’s provider network. Medicare Advantage providers generally cannot bill you more than your cost-share (deductible, coinsurance or copayment) for covered services.

Medicare costs under Medicare Part D

Medicare Part D is prescription drug coverage. Available from private, Medicare-approved insurance companies, Medicare prescription drug coverage can come from a stand-alone prescription drug plan or a Medicare Advantage prescription drug plan. If you enroll in a Medicare prescription drug plan, your Medicare costs for prescription drugs are typically limited to deductibles, coinsurance and/or copayments.

As with Medicare Advantage plans, your Medicare costs can vary among stand-alone Medicare Part D prescription drug plans.

Medicare costs and Medicare providers

If you see a doctor who doesn’t accept Medicare assignment, your Medicare costs can be higher. Medicare providers who accept assignment agree to accept the Medicare-approved amount for the service, and not charge you more than the standard deductible and/or coinsurance/copayment amount.

A doctor who doesn’t accept Medicare assignment usually can’t charge more than 15% more than the Medicare-approved amount. You might have to pay this amount up front. The provider also can’t charge you for submitting a Medicare claim.

Getting help with Medicare costs

Perhaps you decided to stay with Medicare Part A and Part B instead of enrolling in a Medicare Advantage plan. In that case, you might be able to buy a Medicare Supplement insurance plan to help pay your Medicare out-of-pocket costs.

Private insurance plans offer Medicare Supplement insurance plans. These plans generally help pay Original Medicare costs, like coinsurance and deductibles. Your final Medicare costs depend on the standardized benefits of the Medicare Supplement insurance plan you choose.

Take a deeper dive into understanding your Medicare costs

You can learn more about your potential Medicare costs among different Medicare coverage options. It’s easy if you use the tools available right here. Simply type in your zip code in the box on this page and click the button for a listing of Medicare plans where you live and a summary of costs and benefits. You can even type in your current medications to get an estimated prescription drug cost summary by plan.

The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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