People With Medicare
What Medicare Costs (2013)
Most people do not have to pay a premium for Part A because they (or their spouse) paid for it while they worked. If you do have to pay Part A premiums, the longer you or your spouse worked and paid into Social Security, the lower your premiums will be.
|Time Worked||Premium Cost|
|If you or your spouse worked and paid into Social Security:|
|for 10 or more years||$0|
|between 7.5 and 10 years||$243 per month|
|for fewer than 7.5 years||$441 per month|
For a hospital stay, you will pay a deductible of $1,184. This is not an annual deductible. You pay this deductible once each "benefit period." (A benefit period begins when you go into a hospital or skilled nursing facility (SNF), and ends when you have been out of the hospital or SNF for 60 consecutive days.) Your payment changes as you stay in the hospital.
|How Long You Stay||What You Pay|
|Days 1-60||$1,184 deductible, then nothing|
|Days 61-90||$296 per day|
|Days 91-150||$592 per day
These are called "lifetime reserve days" because Medicare will only pay for these extra days once in your lifetime
|After 150 days||The full cost of your hospital stay|
Skilled Nursing Facility Costs:
For a skilled nursing facility stay, there is no deductible. Medicare will only cover up to 100 days in a skilled nursing facility though, and only if you meet some very specific criteria:
- 3-Day Hospital Stay: You must have been at a hospital
- For 3 days AND
- Have been at a skilled nursing facility within 30 days AND
- The hospital must have admitted you as an inpatient. If you went to the emergency room or were under what the hospital calls "observation status," it does not count, even if you stayed overnight.
- Level of Care: You must also need skilled nursing care 7 days a week, or skilled therapy services 5 days a week.
- Part A: Skilled nursing care is covered under Medicare Part A. You must have had Part A while you were in the hospital.
Also, keep in mind that Medicare will NOT cover your stay if you only need help with personal care (also called custodial care), such as bathing, eating, or dressing yourself. Here is what Medicare will pay.
|How Long You Stay||What You Pay|
|Days 21-100||$148 per day|
|After 100 days||All costs|
Home Health Care Costs:
There is no deductible or co-payment for home health care. However, you do need to meet a set of very specific criteria in order for Medicare to cover your home health care.
Medicare covers home health care services when a doctor certifies that:
- You need medical care at home AND
- You are homebound AND
- You need skilled care from a nurse or a skilled physical, speech, or occupational therapist.
Medicare will only cover home care services when your doctor:
- Orders the care from a home health agency that Medicare approves,
- Documents a face-to-face visit with you up to 3 months before or 1 month after the start of the service, AND
- Signs a plan for your care.
There is no deductible or copayment for hospice care. You only pay a small share of the costs of medications and inpatient respite care under the Medicare hospice benefit.
There is a monthly premium for Part B coverage; for most people it is $104.90 in 2013. If your income is $85,000 or more if you're single, or $170,000 or more if you're married you’ll pay more. The higher your income, the higher your premium. Your Part B premium is usually deducted from your Social Security check.
You will also pay an annual deductible of $147 in 2013. That means when you receive services covered by Part B, you will pay $147 before Medicare starts helping you pay.
Once you have paid your deductible, you will then pay 20% of the cost approved by Medicare for most Medicare Part B services. (For outpatient mental health service, you will pay 35% of the costs in 2013.)
To keep your Part B costs down, make sure that your health-care providers take Medicare and "accept assignment." Doctors or other providers who accept assignment agree to accept the amount that Medicare will pay for a visit or service (called the Medicare-approved amount) as payment in full. So you would only pay the 20% coinsurance.
Providers who see people with Medicare, but do not accept assignment can charge you more. They can charge you up to 15% more than the Medicare-approved amount, which means that you would pay your usual 20% co-insurance plus up to an extra 15%. For example, if the Medicare-approved amount for a doctor visit was $100 but your doctor did not accept assignment, he could charge you up to $115 for your visit. You would pay $35 (20% of the $100 Medicare-approved amount, plus the extra $15 not covered by Medicare).
Providers can also "opt out" of the Medicare program. That means that they can charge you whatever they like for a service and will not bill Medicare. If you see a provider that has opted out of Medicare, you will have to pay the full cost of the service you receive; Medicare will not pay any part of the cost. Providers that opt out of Medicare should have you sign a contract saying that you understand that you will have to pay the full cost of the service.
Filling In the Gaps
Some people may have coverage from a current or former employer or union. This employer-sponsored coverage can help to pay for services and costs that Medicare does not cover.
Other people may purchase a Medicare supplemental insurance, known as a Medigap policy. There are 11 different standardized Medigap plans that can be sold. They are labeled A-D, F, high-deductible F, G, and K-N (except in Massachusetts, Minnesota and Wisconsin). Each covers different services. The cost of a Medigap policy depends on the type of Medigap plan and the company you bought it from.