Understanding the costs involved with Medicare is important to understanding where a Medicare plan can fall in your budget. That’s why the expert team with Malhotra & Assoc. Insurance is here to keep you informed and updated on the Medicare costs you can expect for the year.
Cost-sharing with insurance is when the insurance company has you pay a portion of your covered expenses instead of covering them 100%. Most insurance companies have some form of cost-sharing.
Medicare uses cost-sharing for your Medicare Part A and Part B expenses. When you go to the hospital, doctor’s office, or emergency room, you can expect to pay at least part of your medical bill. Fortunately, even with cost-sharing, you will only have to pay up to 20% of the Medicare-approved amount for a covered service, item, or test. These Medicare-approved amounts are standardized for each procedure, lowering the cost substantially from the medical bill the hospital would have given you.
With Medicare, your cost-sharing can include costs like deductibles and coinsurance.
Deductibles
For Medicare Part A, you will need to pay a deductible for each benefit period. A benefit period is the time between when you were first admitted as an inpatient and when you have not received inpatient care for 60 days. The 2021 Medicare Part A deductible is $1,484.
For Medicare Part B, you owe a yearly deductible. The 2021 Medicare Part B deductible is $203. Until you pay the deductible, you are responsible for the full cost of all covered services.
Coinsurance
For Medicare Part A, you will need to pay a daily coinsurance amount once you pass a certain number of days as an inpatient in a hospital, mental health inpatient stay, or skilled nursing facility for each benefit period.
As a hospital inpatient, you will pay nothing but the deductible for the first 60 days. From day 60 to 90, you will have to pay Medicare a daily coinsurance rate of $371. Beyond day 90, you will need to use lifetime reserve days. You have 60 reserve days in your lifetime. For day 91 and beyond, you will pay $742 each day. Once you have used up your lifetime reserve days, you owe all costs. These costs are the same as those for someone in an inpatient mental health facility.
As an inpatient in a skilled nursing facility, you pay only the Part A deductible for the first 20 days. From day 21 through 100, you will have to pay Medicare a daily coinsurance rate of $185.50. Beyond day 100, you owe all costs.
For Part B, once you have paid your deductible, you will need to pay coinsurance for each covered service. Just as we have mentioned previously, the coinsurance is 20% of the Medicare-approved amount. Medicare will pay the remaining 80%.
Medigap Plans
In addition to these costs, you can also expect some cost-sharing if enrolled in a Medicare Supplement (Medigap) plan, more specifically, Medigap Plan K or Plan L. Medigap Plan K will provide full coverage for a single benefit, while providing 50% coverage for five other benefits, leaving you to cover the other 50% of costs. Medigap Plan L is similar to Plan K but instead of 50%, it provides 75% coverage for five benefits.
These five benefits are:
- Part B coinsurance and copayment
- First three pints of blood
- Part A hospice care coinsurance and copayment
- Skilled nursing facility care coinsurance
- Part A deductible
Contact an agent with Malhotra and Assoc. Insurance to learn more about Medicare cost-sharing.
