Premiums, copays, and coinsurance are regular features of health insurance. Original Medicare has a deductible of $1,556 [2022 figure] for each hospital stay. Medigap policies can be purchased to cover the deductible. Medicare Advantage plans have per day co-payments; the amount varies from plan to plan.

The Original plan, Parts A and B, have no out-of-pocket caps, but Medigap plans do cover at least some of the costs. Advantage plans have an out-of-pocket cap of $7,550 for in-network and $11,300 for out-of-network services.

Under the Original plan you will be charged 20% of the cost of a doctor visit after you have met the annual deductible of $233 [2022 figure]; a Medigap policy will pay part or all of the 20%. Depending on your Advantage plan you will pay a flat co-pay for a doctor visit or a percentage of the bill. You will pay less if you use your plan’s network rather than an out-of-network doctor.

You must pay a monthly premium even if you never visit a hospital. Original Medicare Part A is premium-free if you have worked and contributed long enough to the plan. The monthly premium for Part B is $170.10 [2022 figure], but the premium will be higher for those with higher incomes. Part D drug plan premiums vary. Advantage plans require Part B premiums of $170.10; some plans require a second monthly premium as well. There are usually no additional premiums for drugs.

Both Original and Advantage plans cover emergency visits to the hospital. Under the Original plan you will be responsible for 20% of the doctor bills and Part A prices. Costs under Advantage plans are uncertain because they depend on the plan you chose. 

Finally, Medicare is obviously an arcane subject, but it can be worth many dollars of savings to those who take the time to understand its nuances.

Al Popowits
River Forest

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