Medicare coinsurance is the amount of money you have to pay out of your own pocket for medical services you receive after you’ve paid your deductible. It’s a percentage of the Medicare-approved price of the services you receive.
- Written by Terry Turner
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Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
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- Published: May 11, 2020
- Updated: February 3, 2023
- 4 min read time
- This page features 10 Cited Research Articles
Medicare Coinsurance in 2023
Medicare coinsurance kicks in after you’ve paid your Medicare deductible for the year.
The amount for Medicare Part A hospital insurance is a set dollar amount while coinsurance for other Medicare parts are a percentage of the cost of the medical or hospital service you receive.When Medicare Coinsurance Begins
- Part A
- No coinsurance until after 60 days for hospitalization and after 20 days for a skilled nursing stay.
- Part B
- After meeting your $226 deductible, coinsurance is usually 20% of the Medicare-approved cost of most doctor services.
- Medicare Advantage and Part D
- Coinsurance varies from policy to policy.
Medicare Part A Coinsurance
Your Medicare Part A coinsurance responsibility kicks in after you’ve paid your $1,600 deductible for your 2023 benefit period. But you still don’t have to pay coinsurance for the first 60 days of hospitalization even after you’ve paid your deductible.
While most Medicare coinsurance is based on a percentage of the services’ costs, Medicare Part A coinsurance is set at fixed numbers.Daily Coinsurance Costs for Medicare Part A in 2023
- Days 1 to 60 of Hospitalization
- $0 coinsurance
- Days 61 to 90
- $400 per day
- Days 91 and Beyond
- You pay $800 per day for each “lifetime reserve day” beyond 90 days (you only have 60 of these days over your lifetime).
- Beyond 60 Lifetime Reserve Days
- You are responsible for all hospital costs.
- Skilled Nursing Facility Stays
- You pay $0 coinsurance for the first 20 days and $200 for days 21 to 100. You are responsible for all costs from day 101 and beyond.
Medicare Part B Coinsurance
Your Medicare Part B coinsurance responsibility kicks in after you’ve paid your $226 deductible for the 2023 Medicare benefit period.
After meeting the deductible, your coinsurance will usually be 20% of the Medicare-approved price for certain services.Medicare Part B services for which you pay coinsurance include:
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- Most doctor services including hospital inpatient doctor services.
- Outpatient therapy or treatments.
- Durable medical equipment such as walkers, wheelchairs or a hospital bed your doctor may order for your home care.
Coinsurance for Part D and Medicare Advantage
Medicare Part D prescription drug plans and Medicare Advantage plans are sold by private insurers through contracts with the U.S. Centers for Medicare & Medicaid Services. Coinsurance for each of these Medicare parts varies from plan to plan.
There are many cost saving updates coming to Medicare Advantage and Part D within the next few years.Upcoming Coinsurance Changes for Part D and Medicare Advantage
Copays for a 30-day supply of covered insulin will be capped at $35 for select Medicare Advantage and Part D plans. You also won't have any out-of-pocket costs for most vaccines.
Beneficiaries won't have any of out-of-pocket costs when they enter catastrophic coverage.
The maximum out-of-pocket amount you'll pay for perscription drugs will be $2,000.
Medicare Part D Prescription Drug Coinsurance
Your Medicare Part D plan’s design will determine your 2023 coinsurance.
Your Part D deductible can’t exceed $505 in 2023, but the amount of your coinsurance is set by the insurer through which you purchased your Part D coverage. You should check with your Part D insurance provider to find out what your coinsurance will be.
In 2025, all Part D plans will have an option called “smoothed cost-sharing”, which allows you to have your out-of-pocket costs spread out throughout the year. This can help you avoid getting hit with one hefty bill and allow you to make smaller payments.
Medicare Advantage Plans Coinsurance
Medicare Advantage plans typically combine hospital and medical coverage into a single plan that you substitute for Original Medicare. Advantage plans may also include prescription drug coverage.
Your deductible will depend on the particular Medicare Advantage plan you purchased. Once it’s met, you will be responsible for the plan’s deductible until you reach its yearly out-of-pocket limit.
You should check with your insurer to find out the deductible, coinsurance and out-of-pocket limit for your plan. These may change from year to year.
Medigap and Coinsurance
Medigap, also called Medicare supplemental insurance, can offer some help in paying Medicare coinsurance and other out-of-pocket costs associated with your Medicare coverage.
There are 10 different types of standardized Medigap plans sold through private insurers in 47 states and the District of Columbia.
Minnesota, Massachusetts and Wisconsin have different ways of standardizing plans in their states. All Medigap plans cover certain basic benefits.Basic Coinsurance All Medigap Plans Must Cover
- 365 days of additional hospital coverage.
- Full or partial coverage for Medicare Part B coinsurance.
- Hospice coinsurance for drugs and up to five days of inpatient care.
- Medicare Plan A hospital coinsurance.
You may also choose plans that cover differing amounts of coinsurance and other out-of-pocket costs. These include skilled nursing facility coinsurance and excess physician charges — those charges beyond Medicare-approved prices for services.
Remember that you cannot enroll in both Medigap and a Medicare Advantage plan. You have to choose one type or the other.Last Modified: February 3, 2023Share This Page
10 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- Bunis, D. (2022, August 15). Big Changes Coming to Medicare Part D Plans. Retrieved from https://www.aarp.org/politics-society/advocacy/info-2022/medicare-part-d-changes.html)./
- U.S. Centers for Medicare & Medicaid Services. (2022). Yearly Deductible for Drug Plans. Retrieved from https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/yearly-deductible-for-drug-plans
- U.S. Centers for Medicare & Medicaid Services. (2020, January). 2020 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
- U.S. Centers for Medicare & Medicaid Services. (2019, November 8). 2020 Medicare Parts A & B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2020-medicare-parts-b-premiums-and-deductibles
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Part A Costs. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Part B Costs. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Costs for Medicare Advantage Plans. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What's Medicare Supplement Insurance (Medigap)?. Retrieved from https://edit.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
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