Part B deductible

Your Part B deductible is the amount you must pay in medical costs before Medicare begins paying its share.

In 2023, the Part B deductible is $226 per year.

Part B coinsurance/copayment

After you meet your Part B deductible, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services.

Part B excess charges

Doctors who do not accept Medicare assignment can charge more than the Medicare-approved amount for a service or procedure. The difference between the amount a doctor charges and the Medicare-approved amount is known as an excess charge.

The Part B excess charge can be as much as 15 percent more than the Medicare-approved amount.

2023 Medicare Advantage (Part C) costs

Medicare Advantage (Medicare Part C) is an alternative to Original Medicare that provides the same benefits as Medicare Part A and Part B.

• Many Medicare Advantage plans may cover prescription drugs. 
  
  
• Some Medicare Advantage plans also offer coverage for vision, dental and hearing, as well as health and wellness programs such as SilverSneakers to help keep enrollees active and healthy.
  
  
• Some Medicare Advantage plans may offer additional benefits such as transportation to doctor's appointments, grab bars in home bathrooms and healthy meals delivered to your home.

Original Medicare does not cover vision, dental or hearing services that are not considered medically necessary. This includes routine and preventive care.

If you’re enrolled in Original Medicare, you are responsible for 100 percent of the costs related to these services.

If your Medicare Advantage plan includes coverage for prescription drugs, you typically pay a coinsurance or copayment for covered drugs. With Original Medicare, you could pay 100 percent of the costs of many prescription drugs.

Specific prescription drug costs will vary depending on the Medicare Advantage plan you enroll in.

2023 Medicare Advantage premiums

Because Medicare Advantage plans are sold by private insurance companies, there is no standard premium like there is with Original Medicare. Premiums may vary according to plan, insurance carrier and location. 

In 2023, the average monthly premium for a Medicare Advantage plan is $17.60 per month.¹

Depending on where you live, there may be Medicare Advantage plans available that feature $0 premiums, though such plans aren't available in all locations. Beneficiaries are still required to pay their monthly Part B premium.

Medicare Advantage out-of-pocket maximum

Medicare Advantage have an out-of-pocket maximum, which limits how much you could pay out of pocket for care in a given year. Original Medicare does not have an out-of-pocket maximum.

The following chart shows how Medicare Advantage coverage and benefits compare to those of Original Medicare.

2023 Medicare Advantage deductibles

Deductibles for Medicare Advantage plans can vary.

In 2023, the average medical deductible for a Medicare Advantage plan with prescription drug coverage is around $25.44 per year. This low number is partly due to a number of plans that feature $0 deductibles.¹

2023 Medicare Part D costs

Original Medicare does not generally cover prescription drugs, with the exception of limited outpatient prescription drugs.

If you want Medicare prescription drug coverage, you can enroll in a Medicare Advantage plan that includes drug coverage, or you can enroll in a stand-alone Part D (Medicare Prescription Drug Plan) plan.

Compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Part D premiums

If you enroll in a Medicare Part D plan, you typically pay a monthly premium for your Part D coverage in addition to your Medicare Part B and Medicare Advantage premiums (if applicable).

Part D premiums will differ from one plan, carrier or location to another.

The average premium for a Part D plan in 2023 is about $43 per month.²

Some Part D plans may feature $0 deductibles.

As with Medicare Part B, some people who earn a higher income may pay a higher premium for their Part D plan. This increased amount is called the Income-Related Monthly Adjustment Amount (IRMA).

The table below shows what you can expect to pay for your 2023 Part D premiums based on your reported income in 2021.

Part D deductibles

Part D deductibles may vary from one plan to the next.

70% of Part D plans use the standard annual Part D plan deductible in 2023, which is $505.² Some Part D plans may offer $0 deductibles for certain drugs.

Part D coinsurance/copayments

Medicare Part D plans include a drug formulary, which is a list of what drugs the plan may cover.

Medicare plan formularies are divided into tiers. Formulary tiers correspond to how much you might pay in coinsurance or copayments for specific drugs (after you meet your Part D deductible):

• Low-cost, generic drugs are typically on lower tiers.
• More expensive and brand name drugs are typically on higher tiers.

Part D donut hole

Medicare Part D plans have a coverage gap, or “donut hole,” which is a temporary limit on how much a Prescription Drug Plan will pay for prescription drug costs. 

Here’s how the Part D donut hole works:

• Part D plans have an Initial Coverage Limit ($4,660 in 2023), which is the total amount you and your plan can spend on prescription drugs before entering your plan’s coverage gap.
 
• Once you enter the "donut hole" coverage gap, you pay 25 percent of the cost for your covered name brand drugs and generic prescription drugs.
 
• Once you spend $7,400 on prescription drugs in 2023, you will leave the coverage gap and enter catastrophic coverage.
 
• The costs you pay for drugs while in the coverage gap typically contribute to your $7,400 out of pocket total to help get you out of the coverage gap.
 
• With catastrophic coverage, you pay a smaller copayment or coinsurance than you did during the initial coverage phase or while you were in the coverage gap.
 
• Catastrophic coverage remains in effect until the end of the year.

2023 Medicare Supplement Insurance (Medigap) costs

Medicare Supplement Insurance, or Medigap, helps cover some of the out-of-pocket costs that Medicare Part A and Part B don't cover, such as deductibles, coinsurance and copayments.

There are 10 different types of standardized Medigap plans available in most states. The types of costs that different types of Medigap plans are illustrated in the Medigap plans comparison chart below. 

Foreign travel emergency costs

Original Medicare does not typically cover healthcare services received outside of the U.S. and its territories. This means that you are generally responsible for 100 percent of your health care costs while traveling abroad.

Listed below are three exceptions to this rule.

• You’re in the United States when you have a medical emergency and a foreign hospital is closer than the nearest U.S. hospital.
 
• You live in the United States and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat you for your medical condition.
 
• You’re traveling through Canada “without reasonable delay” by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital.

If you have a Medigap plan that helps cover foreign travel emergency costs, however, you could get help covering some of the costs that Original Medicare would not otherwise typically pay.

Medicare Advantage eligibility and enrollment

Once you’re enrolled in Medicare Part A and Part B, you may be able to enroll in a Medicare Advantage plan.

Speak with a licensed insurance agent to learn more about your options and to compare Medicare Advantage plans in your area.