Medicare coinsurance is the share of the medical costs that you pay after you’ve reached your deductibles.

Although original Medicare (part A and part B) covers most of your medical costs, it doesn’t cover everything.

Medicare pays a portion of your medical costs, and you’re responsible for the remaining amount. You can either pay out of your pocket or purchase a Medicare supplement (Medigap) plan to cover these costs.

Keep reading to learn more about Medicare coinsurance and how much you might pay based on the plans you’re enrolled in.

If you have Medicare Part A and are admitted to a hospital as an inpatient, this is how much you’ll pay for coinsurance in 2021:

  • Days 1 to 60: $0 daily coinsurance
  • Days 61 to 90: $371 daily coinsurance
  • Day 91 and beyond: $742 daily coinsurance per each lifetime reserve day (up to 60 days over your lifetime)

If you’re admitted to a skilled nursing facility, this is the breakdown of 2021 coinsurance costs:

  • Days 1 to 20: $0 daily coinsurance
  • Days 21 to 100: $185.50 daily coinsurance
  • Day 101 and beyond: all costs

With Medicare Part B, after you meet your deductible ($203 in 2021), you typically pay 20 percent coinsurance of the Medicare-approved amount for most outpatient services and durable medical equipment.

Medicare coinsurance example

You’re enrolled in original Medicare, and you visit your doctor for a $500 outpatient treatment. Your doctor appointment is covered by Medicare Part B. Your doctor bills Medicare for $500.

In 2021, Part B carries an annual deductible of $203, so you’re responsible for paying this amount toward Part B-covered services for the year.

After paying the Part B deductible, the remaining $297 of your bill is covered in part by Medicare and in part you through coinsurance.

Your share is 20 percent coinsurance of $59.40, and Medicare Part B’s share is 80 percent, or $237.60.

On the next $500 bill for the same treatment from the same doctor, you’ll have already paid your Part B deductible, so Medicare will pay 80 percent ($400) and you will pay 20 percent ($100).

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Medicare supplement or Medigap plans cover various types of Medicare coinsurance costs. Here’s a breakdown of what Medigap plans cover in terms of Part A and Part B coinsurance.

Plan A and Plan B cover:

  • Part A coinsurance and hospital costs up to 365 days after you’ve used up your Medicare benefits
  • Part A hospice coinsurance
  • Part B coinsurance

Plan C, Plan D, Plan F, Plan G, Plan M, Plan N cover:

  • Part A coinsurance and hospital costs up to 365 days after you’ve used up your Medicare benefits
  • Part A hospice coinsurance
  • Part B coinsurance
  • skilled nursing facility coinsurance

Plan K covers:

  • Part A coinsurance and hospital costs up to 365 days after you’ve used up your Medicare benefits
  • 50 percent of Part A hospice coinsurance
  • 50 percent of Part B coinsurance
  • skilled nursing facility coinsurance

Plan L covers:

  • Part A coinsurance and hospital costs up to 365 days after you’ve used up your Medicare benefits
  • 75 percent of Part A hospice coinsurance
  • 75 percent of Part B coinsurance
  • skilled nursing facility coinsurance

With original Medicare (parts A and B), once you’ve reached your deductibles, Medicare pays a share of the cost of Medicare-approved treatments and you pay a share. Coinsurance is your share of the costs.

You can either pay the coinsurance out of your pocket or purchase a Medicare supplement (Medigap) plan to cover all or part of it.

This article was updated on November 20, 2020, to reflect 2021 Medicare information.

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