Medicare shares costs with you in four ways:
- Premium—a fixed fee that you pay each month
- Deductible—an amount you must pay out-of-pocket before your plan will begin paying some of your costs
- Copayment (copay)—a fixed amount you pay each time you use a service, fill a prescription or buy a product
- Coinsurance—a percentage of the cost for a service or product
Here’s a run-down of these costs for Parts A and B in 2013.
What You’ll Pay for Part A
Medicare Part A is hospital insurance. Coverage generally includes:
- A semi-private room
- General nursing care
- Other hospital services and supplies
Part A is premium free for most people. You will pay a premium only if you or your spouse did not work and pay taxes for at least ten years. The 2013 Part A premium is $441 per month.
Part A charges a deductible for each benefit period. A benefit period begins the day you go into a hospital or skilled nursing facility. It ends when you have been out for 60 days in a row. You may have more than one hospital stay during a benefit period. Medicare does not limit the number of benefit periods that it will cover. The 2013 Part A deductible is $1,184 per benefit period.
In addition, you are responsible for some copayments and coinsurance for inpatient stays. The table below shows your portion of the costs.
|Covered Inpatient Care
|Hospital days 1-60
||$0 (after deductible)
|Hospital days 61-90
||$296 per day
|Hospital days 91+
(“lifetime reserve” days)
|$592 per day (maximum of 60)
|Skilled nursing facility days 1-20
||$0 (after deductible)
|Skilled nursing facility days 21-100
||$148 per day
|Skilled nursing facility days 101+
||100% of costs
It’s important to know that you must be admitted to the hospital by doctor’s order. If you are there only for observation, Part A will not cover the cost. Always ask whether you have been admitted as an inpatient. In addition, you must be in the hospital as an inpatient for at least three days to qualify for follow-up care in a skilled nursing facility. The day of your discharge does not count.
Some other Part A covered services and your related costs include:
- Mental health services in the hospital: 20% of Medicare-approved amount
- Home health care: $0 (after deductible)
- Durable medical equipment used at home (wheel chairs, walkers, etc.): 20% of Medicare-approved amount
- Hospice care: $0 (no deductible)
- Outpatient prescriptions for pain and symptom management during hospice: $5 per prescription
- Caregiver respite care during hospice: 5% of Medicare-approved amount
Finally, Part A does not cover doctor services in the hospital—Part B does.
What You’ll Pay for Part B
Medicare Part B is medical insurance. It covers doctor visits and outpatient care.
You must pay a premium for Part B. Find your tax filing status and your income to see what you’ll pay in 2013.
|If you file an individual tax return and your income is:
||If you file a joint tax return and your income is:
||Your Part B premium is:
|$85,000 or less
||$170,000 or less
||$104.90 per month
|$85,001 to $107,000
||$170,001 to $214,000
||$146.90 per month
|$107,001 to $160,000
||$214,001 to $320,000
||$209.80 per month
|$160,001 to $214,000
||$320,001 to $428,000
||$272.70 per month
||$335.70 per month
In addition to the monthly premium, your Part B costs include an annual deductible of $147. You are also responsible for some copayments and coinsurance, including:
- 20% of the Medicare-approved amount for doctor services, outpatient therapy and durable medical equipment
- 20% of the Medicare-approved amount for most doctor services you receive while in the hospital
- $0 for Medicare-approved clinical laboratory services (after deductible)
- $0 for home health care services (after deductible)
- 20% of the Medicare-approved amount for doctor visits to diagnose a mental health condition and to monitor or change prescriptions
- 35% of the Medicare-approved amount for outpatient mental health treatment
There may be additional costs that Part B may help with. You can contact your State Health Insurance Assistance Program for answers to your questions.
Help Paying for What’s Not Covered
Out-of-pocket costs for a serious illness can mount up quickly.
You can add a Medicare supplement insurance plan (Medigap) to Original Medicare to help pay some out-of-pocket costs. Many beneficiaries choose to add a prescription drug plan (Part D) as well. Original Medicare does not include prescription drug coverage.
You may want to look into Medicare Advantage plans (Part C) in your area. These plans combine the coverage of Part A and Part B. Most also include prescription drugs (Part D) and extra benefits like vision, dental and hearing care—all in one plan.
–This information was provided by Medicare Made Clear
GeorgeLitchfield.com– If you or someone in your family is 65 or older and is in need of a Medicare Supplemental Plan or already has a plan, but wants to make sure that it is the right plan please give us a call (888)891-5557 or go to our website GeorgeLitchfield.com and we will give you a quote and help you keep money in your pocket.