Medicare Premiums, Deductibles, and Copays Change for 2019

Here are the new numbers for Medicare premiums, deductibles, and copays for 2019.

Part A Costs

Most people don't pay a monthly premium for Medicare Part A (hospital insurance). But if you have to pay for Part A because you or your spouse don't have a long enough work history, you'll pay between $240 (for 30-39 work credits) and $437 (for fewer than 30 work credits).

In 2019, you’ll also pay a $1,364 deductible for each benefit period in which you use hospital or skilled nursing inpatient care, in addition to the following copays.

• Hospital days 61-90: $341 coinsurance per day of each benefit period
• Hospital days 91 and beyond: $682 coinsurance per each lifetime reserve day for each benefit period
• Skilled nursing days 21-100: $170.50 coinsurance per day of each benefit period.

Part B Costs

The standard Medicare Part B premium is $135.50 in 2019. But some people who were enrolled in Medicare in 2019 or earlier will pay slightly less because of a hold harmless provision that doesn't allow Social Security payments to be reduced from year to year for Medicare premiums.

If you first enroll in Medicare Part B during 2019, or you are not collecting Social Security benefits, your premium will be $135.50 per month. Also, if your adjusted gross income is over $85,000 (or $170,000 for a couple), the monthly premium is higher. These premiums have increased for 2019 and there's a new bracket for individuals making over $500,000 and married couples making over $750,000, as follows:

The Part B deductible for 2019 increases slightly to $185 per year.

The caps on the following Part B services for 2019 remain unchanged, though these amounts may be increased if your therapist tells Medicare that more care is medically necessary and Medicare approves:

• outpatient physical therapy and speech-language pathology combined: $2,010
• occupational therapy: $2,010.

Part D Costs

Part D premiums vary depending on the plan you choose, with an average $32.50 (down about % from last year). The maximum Part D deductible for 2019 is $415 per year (though some plans waive the deductible completely).

Also, if your adjusted gross income is over $85,000 (or $170,000 for a couple), you will pay a monthly adjustment amount to Medicare in addition to your monthly Part D premium. In 2019, there's a new bracket for individuals making over $500,000 and married couples making over $750,000. Here are the Part D additional amounts for individuals making over $85,000 and married couples making over $170,000.

These new brackets for Part B and Part D will help fund generous changes to the "donut hole" for 2019. The donut hole (coverage gap) begins when you spend $3,820 on drug costs and ends at $5,100 of out-of-pocket spending. However, in 2019, while you are in the donut hole, you will now pay only 37% of the cost of generic drugs and 25% of the cost of brand name prescription drugs. The 25% copay for brand name drugs is the same copay as those who haven't reached the donut hole, so the new rules in 2019 remove the donut hole for brand name drugs. When you are on the other side of the donut hole, you pay 5%, or $3.40 for generics and $8.50 for brand name drugs, whichever is greater.

There are subsidies available to pay for Part D for those with low income (called Extra Help). See Nolo’s article on Extra Help for Part D for more information.

Effective date: Jan 01, 2019