How to Evaluate Medicare Plan Costs

Published by: Medicare Made Clear

Medicare shares the cost of your health care with you. What you pay depends on what Medicare coverage you have (the kind of Medicare plan or plans) and how you use it.


Let’s quickly look at the potential costs you may pay. Your cost sharing may include some or all of the following:


  • Premium: A fixed fee that you pay—usually monthly—to your plan, to Medicare or to both.
  • Deductible: An amount that you have to pay out-of-pocket before your plan will begin to pay some of your health care costs.
  • Copayment (copay): A fixed amount—typically $10 or $20—that you pay each time you see your doctor, fill a prescription or use other covered services.
  • Coinsurance: A percentage of the cost for a service or product—usually 20%—that you pay. Your plan pays the rest.


It may also be helpful to look at how these different types of cost-sharing work together. For example, plan premiums generally go down as deductibles go up. The plan charges you less each month, and you pay more out-of-pocket for the services you use. The reverse is also true. As premiums go up, deductibles may go down. Also, plans usually charge a copayment or coinsurance for any given service—not both. Copayments may be less than coinsurance amounts for the same service.



Now that you know what costs to look for, how do you evaluate a Medicare plan for costs?


First, you need to look at all the costs charged by the Medicare plan you have or are thinking of getting. Then, you also need to consider how you use health care and your Medicare benefits. What this means is that you need to think about what specific health services or items you need, how often and then match potential costs to that.


Looking at plan costs and your health care usage together will give you an idea of your out-of-pocket costs. This can help you decide which plan provides the coverage you need at a price you are comfortable with. Here are a few questions to get you started:


  • How often do you visit the doctor? Do you have a copay each time you go? How much is it?
  • What does your doctor charge for an office visit? It’s worth knowing. If your plan charges coinsurance, then you will pay a portion of your doctor’s fee.
  • What prescription medications do you regularly take? How much do you pay to fill a prescription?
  • Do you have a chronic condition that requires regular monitoring and supplies, such as diabetes? What do you pay for supplies?
  • Do you travel frequently or live part of the year in a different state? Is your care covered when you are away?
  • Do you have a particular doctor you like to see? Does your doctor accept the amount Medicare pays for services as payment in full?


Evaluating a Medicare plan’s costs can be simple if you keep these two steps in mind. Again, you want to first look at the cost types a plan has, then make an estimate of your total annual costs based on what health care items you need or use. 

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Learn more about Medicare premiums, copayments, coinsurance, out-of-pocket limits and more.

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