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Medicare Benefits and Out-of-Pocket Costs in 2009 The “Parts” of Medicare and Covered Services
Part A Automatically included with no premium for most Inpatient hospital • Up to 90 days per year • Plus 60 “lifetime reserve days” Skilled nursing facility - up to 100 days per year Hospice care for terminally ill beneficiaries Home health care for homebound beneficiaries needing skilled care Premium Deductible Physician and other medical services including: supplies durable medical equipment and physical and speech therapy Outpatient hospital care Ambulatory surgical services Laboratory services Outpatient mental health services Premium Deductible Coinsurance $1068 deductible for the first stay in during a year • Days 1 - 60: $0 • Days 61 - 90: $267 per day • 60 “lifetime reserve days”: $534 per day • Days 1 - 20: $0 • Days 21 - 100: $133.50 per day Nominal coinsurance for drugs and respite care $0
Out-of-Pocket Cost
Part B Optional you pay a premium to Medicare – usually deducted from your Social Security check $1156 - $3699.60 annually or $96.40 - $308.30 per/month a depending on income $135 annually 20 percent of Medicare-approved amount
Greater of 20 percent of Medicare-approved amount or 20 b percent of 1996 national median charge updated to 2000 20 percent of Medicare-approved amount $0 50 percent of Medicare-approved amount Approximately $444 annually or $37 per month varies by insurance company $ 0 to $295 annually depending on plan 25 % on costs from $295 to $2510 100 % from $2510 to $5726 minimal cost sharing above $5726 out of pocket threshold $4350
Part D Optional you pay a premium to a Medicare approved plan
Note:
a
The Part B premium increases from $96.40 to $238.40 per month based on a sliding scale for individuals with incomes above $82,000 and below $205,000 and for couples with incomes above $164,000 and below $410,000. b Because outpatient charges are often higher than Medicare approved changes, Medicare beneficiaries’ coinsurance rates are often well above the 20% of the Medicare approved amount. For example, the average coinsurance rate for imaging services was 42 % of the cost in 2005.
Revised: February 20, 2009
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