How Much Does Medicare Actually Cost? We Break It All Down Here.
Medicare is a huge program that is used by millions of Americans each year, and is a trillion (yes, trillion) dollar government program.
“According to the Centers for Medicare and Medicaid, national health spending will grow at an average annual rate of 5.4 percent for the years 2019-28 and reach $6.2 trillion by 2028,” says Dr. Steven Goldstein, MD, founder of the Houston Healthcare Initiative.
And it is only expected to grow.
From Parade Magazine: How Much Does Medicare Actually Cost? We Break It All Down Here. “Medicare is expected to experience the fastest spending growth of 7.6 percent per year from 2019-to 2028, largely as a result of the highest projected enrollment growth,” adds Dr. Goldstein.
Medicare costs are set by a combination of healthcare providers.
“To provide healthcare for more than 60 million people, including older people and those with disabilities or end-stage renal disease, Medicare sets payments and rules for services provided by a wide range of healthcare providers – physicians, hospitals, laboratories, ambulances, etc.,” says Jennifer Podulka, MPA, Senior Consultant for Health Management Associates. “At the same time, new healthcare products and treatments are constantly being introduced, which is extremely beneficial for consumers, but Medicare has to keep up by regularly setting new payments and issuing new rules.”
These can make the cost of Medicare hard to nail down, as they are constantly changing. However, one general rule is that the price of Medicare will depend on the plan you have.
“Medicare costs differ based on whether people have original Medicare or Medicare Advantage,” says Jane Sung, Senior Strategic Policy Advisor in AARP’s Public Policy Institute.
For original Medicare, costs are calculated the same way for everyone in the program, with monthly premiums and cost-sharing responsibilities such as annual deductibles and coinsurance, according to the Centers for Medicare & Medicaid Services. (See Medicare Costs at a Glance here.) The costs for 2021 are estimated as follows:
Medicare 2021 Costs
Part A monthly premium: Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $471 each month. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $259.
Part B monthly premium: Most people pay the standard Part B premium amount ($148.50 in 2021). For Part B deductible and coinsurance, it is $203. After your deductible is met, you typically pay 20% of the Medicare-Approved Amount.
Part C Premium: The Part C monthly premium varies by plan, and can be compared here.
Part D monthly premium: Your estimated drug plan monthly premium is based on your income, and higher-income consumers may pay more. (See link above for chart.)
“Original Medicare requires cost-sharing, so many people have some form of supplemental coverage that helps pay for their share of the costs, either through a retiree health plan, Medicaid or by purchasing a Medigap policy,” says Sung.
But for those on Medicare Advantage, this differs.
However, costs for Medicare Advantage plans have a $0 premium, according to the Centers for Medicare & Medicaid Services.
If you recently joined Medicare, you likely have a lot to learn about how the program works and what services are covered. However, Medicare is a huge program, and it can feel overwhelming to find out which services are covered by your plan and those that are not. On top of that, healthcare products and treatments are constantly evolving, especially during the COVID-19 pandemic, which has resulted in Medicare currently covering many items and services on a temporary basis.
“Most people learn about new healthcare products and treatments that have been added to Medicare from their physicians. To share this information with their patients, physicians must find time to keep up with the latest information about Medicare offerings, while continuing to focus on their core mission of treating patients,” says Jennifer Podulka, MPA, Senior Consultant for Health Management Associates. “It’s hardly surprising that some new things slip through the cracks.”
To help you get informed, we created a list of 12 things that you may be surprised to learn are covered by Medicare from various experts.
12 Surprising Things that Are Covered by Medicare
Surprising Thing #1: Telehealth
Before the coronavirus pandemic, telehealth services covered under Medicare were very limited, notes Wyatt Koma, Policy Analyst for the Kaiser Family Foundation. However, as a result of it and the declaration of a public health emergency, Medicare lifted restrictions for telehealth on a temporary basis.
“Through the rest of the public health emergency, which will likely be the remainder of 2021, people with traditional Medicare can use telehealth to video chat with their doctor or talk to them over the phone if they have a medical problem,” says Koma. “People in a Medicare HMO or PPO—known as Medicare Advantage plans—can also use telehealth to get needed care, if offered by their plan.”
Surprising Thing #2: Substance use disorder treatment
“This is a new benefit offered by Medicare that is potentially life-saving. Opioid use disorder treatment was added in 2020, and treatment for other substance use disorders was added January 1, 2021,” says Podulka.
She notes that medicare pays for ongoing, medication-assisted treatment for people with substance use disorders. And eligible providers include clinics that focus on opioid use disorder, as well as physicians who opt to provide this service for their patients.
“Providers can tailor treatment to the unique needs of each patient by determining the best mix of counseling sessions and appropriate medication,” says Podulka.
Surprising Thing #3: Free COVID vaccines and tests
Older adults continue to be one of the populations hardest hit by the coronavirus pandemic and have been at the greatest risk of hospitalization and death due to COVID-19 compared to other age groups. Seniors and younger adults with permanent disabilities with health coverage under Medicare can get free COVID vaccines and tests, without having to pay any cost-sharing for these services.
Surprising Thing #4: Pain management
If you struggle with pain, certain treatments are covered by Medicare. “If you are in pain, Medicare covers acupuncture and chiropractic services under certain circumstances,” says Alison Reeves, Press Officer for the Centers for Medicare & Medicaid Services.
Surprising Thing #5: Medicare Diabetes Prevention Program (MDPP)
Half of adults age 65 or older have prediabetes, the condition that may lead to type 2 diabetes, according to Harvard Medical School. In response, Medicare created a program for those with prediabetes with the goal of prevention.
“The Medicare Diabetes Prevention Program (MDPP) is a proven, structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic,” says Podulka. “The clinical intervention consists of 16 intensive ‘core’ sessions of a curriculum in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the 16 core sessions, less intensive monthly follow-up meetings help ensure that the participants maintain healthy behaviors.”
According to Podulka, this benefit began to be offered by Medicare beginning in 2018.
Surprising Thing #6: Coverage of dental services in emergency situations
“Dental benefits are not generally covered by Medicare, except under limited circumstances, and many people on Medicare do not have any dental coverage at all,” says Koma. “Medicare does not generally cover preventive dental care, although it may be offered as an extra benefit in Medicare HMOs or PPOs (also known as Medicare Advantage plans).”
He also notes that because many Medicare beneficiaries do not have dental coverage, Congress is now debating whether to add a dental benefit to Medicare, along with hearing and vision benefits.
Surprising Thing #7: Consultation with a registered dietitian
Many older Americans not only struggle with making healthy nutrition decisions, they also suffer from chronic diseases caused by poor diet, including diabetes.
“Medicare offers 1) medical nutrition therapy (MNT) for people with diabetes or renal disease and 2) diabetes self-management training (DSMT) for people with diabetes,” says Podulka. “Eligible patients must be referred by their treating physician and can receive 3 hours of 1-on-1 MNT counseling in the first year and two hours in subsequent years or up to 10 hours initial DSMT training in the first year and up to 2 hours follow-up training each calendar year after completing the initial 10 hours.”
Surprising Thing #8: Certain cancer treatments
As cancer treatments continue to evolve, Medicare has also begun to cover the latest and greatest treatments available.“Medicare coversinnovative technologies, including next-generation sequencing cancer treatments,” says Reeves.
Surprising Thing #9: Free preventive services
“Within their first year of Medicare coverage, people are eligible for a free ‘Welcome to Medicare’ physical exam, and for each year moving forward they can get a free annual wellness visit,” says Koma.
Surprising Thing #10: Transitional care management (TCM) services
Transitioning from an inpatient to an outpatient setting is a new and stressful experience for many people, and Medicare has responded with TCM services to support patients.
“As part of TCM services, Medicare pays physicians or qualifying nonphysician practitioners to provide care management services for a patient to facilitate the transition,” says Podulka.
Surprising Thing #11: Obesity screenings and counseling
According to the Centers of Disease Control and Prevention, more than a third of adults age 60 and older are obese, and obesity contributes to serious health risks.
“Medicare covers obesity screenings and behavioral therapy sessions, including a dietary assessment to help beneficiaries lose weight by changing their diet and exercise,” says Koma. “These services are offered without cost-sharing.”