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Medicare costs and help paying them

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The Medicare Advocacy Project at Community Legal Aid, Greater Boston Legal Services, and South Coastal Counties Legal Services
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Medicare is divided into 4 different parts: A, B, C, and D. Read this article to learn:

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How much does Medicare cost?

The different Medicare parts each have different costs:

  • Premiums are regular insurance payments, most often a set amount paid monthly.
  • Deductibles are amounts paid each year toward medical care before Medicare starts to help pay.
  • Copayments are the share of each medical bill you must pay. Each copayment is a flat rate paid for a Medicare-covered service. 
  • Coinsurance is an amount you must pay after your deductible is paid. Once you pay your deductible, any remaining cost is split: Medicare pays a percentage, and you pay the rest. The percentage you, the insured person, pay is called “coinsurance.”

Note: 

Medicare costs go up almost every year. Figures in this article are for 2024 unless otherwise noted.

part-a
Part A: Hospital insurance
For Example

For the first 60 days you are in the hospital, you may owe up to a $1,632 deductible and no coinsurance. Then, for days 61 to 90 of your hospital stay, you will pay $408 per day as coinsurance.

Premiums

  • If you or your spouse worked and paid into the Medicare system for at least 10 years, you will not pay a Part A monthly premium.
  • If you get Social Security Retirement benefits or Railroad Retirement benefits, you will not pay a Part A monthly premium.
  • If neither you nor your spouse paid into the system for at least 10 years, you must pay a monthly Part A premium. In 2024, the Part A premium can cost up to $505 per month. Your premium depends on how long you worked and how long you paid into the system.

Deductibles, copayments, and coinsurance

The other expenses under Medicare Part A are different depending on if you go to a hospital, hospice, or skilled nursing facility, or you get home health care, and the details of your stay.

Part B: Supplementary Medical Insurance

Premiums

Part B premiums are based on income. In 2024, most people's Part B premiums are $174.70 per month. If you are single and make at least $91,000 a year, or married and make at least $182,000, your premium will be higher than this. Depending on income, your Part B premium could be as high as $578.30 each month.

Deductibles

The 2024 Part B deductible is the first $240 of Part B-covered services or items.

Copayments and coinsurance

For Part B services, Medicare generally pays 80% of the bill. Your coinsurance is the remaining 20%.

Part C: Medicare Advantage

Medicare Advantage plans are offered by private companies that contract with Medicare. If you decide to enroll in a Part C Medicare Advantage plan, you must pay the:

  • Part B premium,
  • Part A premium if you have one,
  • Part C premium that your plan charges for extra coverage, and
  • Deductible, coinsurance, and copayment rates set by your Part C plan.
Part D: Prescription Drug Insurance

Premiums

  • Part D monthly premiums in Massachusetts vary. Your plan will set your premium amount.
  • The national monthly base premium for 2024 is $34.70.
  • Your premium is higher if you are single and make $103,000 a year or more, or if you are married and together make $206,000 or more.

Deductibles

Part D plans set their own rates. They cannot charge more than $545 for an annual deductible in 2024.

Coinsurance and copayments

  • Part D plans set their own coinsurance and copayment rates.
  • After you pay your deductible, you may have to pay up to 25% of your out-of-pocket drug costs, up to $5,030. “Out-of-pocket drug costs” include the amount you pay for your covered medications, as well as some costs that may be paid by others. 
  • Once you have spent $5,030 on drug costs, until you spend $8,000, you fall in the “coverage gap.” You may have to continue to pay 25% of your drug costs while you are in the “coverage gap,” sometimes referred to as the “donut hole.”
  • After you reach $8,000 in out-of-pocket costs for covered drugs, you reach “catastrophic coverage.” In the catastrophic coverage phase, in 2024, you will not owe anything for Part D prescription drugs. 
  • In 2025, this structure will change. Part D will have a $2,000 out-of-pocket cap, instead of this tiered structure.

To see more cost details, visit the Medicare website.

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What if I can’t afford Medicare?

Several programs can help you pay different Medicare costs. Your income and assets must be low enough to use these programs. 

Income is the money you earn or get each month. Assets are things you own, like savings accounts, jewelry, a boat, stock, etc.

msp
Medicare Savings Programs

Medicare Savings Programs (MSP) help low-income people of any age on Medicare get benefits at a lower cost. It is free to enroll in these programs.

The programs are commonly known as MassHealth Buy-In and MassHealth Senior Buy-In. You may also hear MassHealth Buy-In referred to by other names: Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs. MassHealth Senior Buy-In is also referred to as the Qualified Medicare Beneficiary (QMB) program.

The MSP program you qualify for depends on your income. Each MSP program has different benefits. All MSP programs pay your Part B premium and help pay for prescription drug coverage under Part D. 

The Senior Buy-In or QMB program pays your Part A premium. It also pays for your Part A and B copayments and deductibles to MassHealth providers.

How do I qualify?

To qualify for the Medicare Savings Programs (MSP), they look at your “countable income." Countable income is your total income minus some deductions. 

As of March 1, 2024, MSP will not look at your assets anymore to see if you are eligible. 

To qualify for MSP:

  • If you are single, your countable income must be less than $2,824 per month.
  • If you are married, your combined countable income must be less than $3,833 per month.

You can also have up to $1,500 per person set aside for burial costs in a separate bank account.

How do I apply?

You can:

  • Call the MassHealth Enrollment Center for an application: 1-888-665-9993. If you apply for Supplemental Security Income or SSI, they should automatically see if you are eligible for MSP.
  • Get the form online (PDF and Word). Mail, fax, or hand-deliver it to the MassHealth Enrollment Center.

Sign the filled-out application. 

Mail it to:

MassHealth Enrollment Center
PO Box 4405
Taunton, MA 02780-0968 

Fax it to:  (857) 323-8300 

Hand-deliver it to: 

MassHealth Enrollment Center  
The Schrafft Center  
529 Main St., Suite 1M  
Charlestown, MA 02120

extra-help
Extra Help with Part D prescription drug costs: Low-Income Subsidy Program

The Social Security Administration offers the Extra Help program, also known as the Low-Income Subsidy Program, to help pay for some Medicare Part D costs. They may pay for premiums or deductibles, coinsurance, and copayments.

As of 2024, Extra Help members will pay $0 for Part D premiums or deductibles. They will be eligible for fixed, lower copayments for certain medicines. Covered prescription copays will be no more than $4.50 for one month’s supply of each generic drug and $11.20 for one month’s supply of each brand-name drug. 

How do I qualify?

As of 2024, to qualify for Extra Help:

  • If you are single, your countable income must be less than $22,590per year. Your countable assets must be worth less than $17,220.
  • If you are married, your countable income together must be less than $ 30,660per year. Your countable assets together must be worth less than $ 34,360. 
  • If you enroll in a Medicare Savings Program, even if your income is higher than these limits you automatically qualify for Extra Help.

How do I apply?

Some people get Extra Help automatically. If you are enrolled, Medicare or the Social Security Administration will write to you. If you do not get a letter about Extra Help, you can apply online or call the Social Security Administration at 1-800-772-1213.

prescription-advantage
Prescription Advantage

Prescription Advantage is a prescription drug insurance plan. It is for most Massachusetts residents who are 65 or older. Younger people who meet MassHealth’s CommonHealth disability guidelines, income limits, and employment limits may also qualify. Prescription Advantage may help pay all or part of your Medicare prescription drug plan’s copayments.

Prescription Advantage sets an out-of-pocket spending limit that depends on your income. Once you have spent enough to reach this limit, Prescription Advantage will cover drug copayments for the rest of the plan year.

How do I qualify?

Medicare-eligible Prescription Advantage applicants in 2024 must have a gross annual household income less than 500% of the 2024 federal poverty level:

  • If you are single, your income must be less than $75,300.
  • If you are married, your combined income must be less than $102,200.  

How do I apply?

To apply, contact Prescription Advantage Customer Service at 1-800-243-4636. Choose Option 2. If you have a low income and might qualify for the Medicare Savings Program, you must apply.

medigap
Medigap

Some private insurance companies sell Medigap policies. These policies help you pay for expenses like coinsurance. Enrollees must pay a monthly Medigap premium, in addition to their monthly Part B premium.

Medigap policies follow strict rules about benefits, coverage, and when you can apply. The best time to buy a Medigap policy is during the 6-month period that begins when you are 65 and first enroll in Part B. After that period, it may be harder to buy a Medigap policy.

To find out more about eligibility and enrollment in Medigap policies, see Medicare's Medigap Policy Search or download their PDF, “Choosing a Medigap Policy”. You can also call 1-800-MEDICARE.

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See more in

Resource Boxes
More Resources
Programs that can answer your questions
Health_Medicare_SHINE and hotlines

SHINE (Serving the Health Information Needs of Everyone): 1-800-243-4636, press 3 
The SHINE (Serving the Health Information Needs of Everyone) Program provides free health insurance counseling services to Massachusetts residents with Medicare or who are about to become eligible for Medicare, and their caregivers. SHINE counselors are trained to handle complex questions about Medicare.

MCPHS University Pharmacy Outreach Program: 1-866-633-1617
The MCPHS University Pharmacy Outreach Program can review your information to find help for your prescription costs. It can also help you understand your Medicare prescription drug plan benefit.

Health Care For All’s Helpline: 1-800-272-4232
Call or fill out the online form. The Helpline is a free service that helps enroll Massachusetts residents into health insurance coverage. In English, Spanish, Portuguese, Haitian Creole, and French.

Get help from the Medicare Advocacy Project
Health_Medicare_Medicare Advocacy Project

The Medicare Advocacy Project (MAP) helps people who may have been unfairly denied Medicare. MAP can give you information, advise you, and sometimes represent you for free. Contact MAP via your local legal services office:

Greater Boston Legal Services (GBLS)
Serving Essex, Middlesex, Norfolk, and Suffolk counties: 617-371-1234; 800-323-3205

South Coastal County Legal Services (SCCLS)
Serving Bristol and Plymouth counties: 800-244-9023; 508-979-7150
Serving Fall River: 800-244-9023; 508-676-6265
Serving Barnstable, Dukes, Nantucket, and Plymouth counties: 800-244-9023; 508-775-7020

Community Legal Aid (CLA)
Serving Berkshire, Franklin, Hampden, Hampshire, and Worcester counties: 855-252-5342
 

Medicare, MassHealth, and Prescription Advantage Programs
Health_Medicare_Medicare, MassHealth, and Prescription Advantage Programs

Medicare: 1-800-MEDICARE
Medicare is a national health insurance program. It is for people who are 65 or older and adults with disabilities. 

MassHealth: 1-800-841-2900
The MassHealth program provides comprehensive health insurance — or help paying for private health insurance.

Prescription Advantage: 1-800-243-4636, press 2
Prescription Advantage is a prescription drug insurance plan for all Massachusetts residents age 65 and older, as well as younger people with disabilities who meet income and employment guidelines.

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