MEDICARE OUT OF POCKET
The Medicare program provides significant medical coverage for its millions of enrollees, but the out-of-pocket expenses that come with that coverage can be substantial.
Medicare out-of-pocket costs can range from small co-payments for routine care to large expenses for uncovered treatments. Out-of-pocket service costs can be even higher for those with certain diseases or those living in long-term care facilities. As Medicare out-of-pocket costs increase, it is important to understand the types of expenses you may face when utilizing the Medicare program and how Medicare Supplement insurance can help reduce some of these out-of-pocket costs.
In 2010, Medicare beneficiaries with one hospitalization spent an average of $4,475 on out-of-pocket medical services per year, whereas those with two or more hospitalizations spent an average of $6,216. Other major costs that burden Medicare beneficiaries are custodial care, long-term care, and end-of-life care.
Medicare Part A provides skilled nursing facility care for those who were recently admitted to the hospital, but it does not provide coverage for long-term care such as extended stays in nursing homes or assisted living facilities. The cost of this care can burden beneficiaries, according to the KFF report. For the small percentage of Medicare beneficiaries who live in long-term care facilities, the average out-of-pocket service costs average $17,534 per year, according to the Henry J. Kaiser Family Association. This large annual cost is for facility expenses, inpatient hospitalizations, and care services.
Medicare out-of-pocket costs can range from small co-payments for routine care to large expenses for uncovered treatments. Out-of-pocket service costs can be even higher for those with certain diseases or those living in long-term care facilities. As Medicare out-of-pocket costs increase, it is important to understand the types of expenses you may face when utilizing the Medicare program and how Medicare Supplement insurance can help reduce some of these out-of-pocket costs.
Original Medicare Expenses
Original Medicare (Medicare Part A and Medicare Part B) helps pay for various health care services such as hospitalization, hospice care, doctor’s visits, and preventative care. Original Medicare has different costs for Part A and Part B, although most people will not have to pay a monthly premium for Medicare Part A. Original Medicare does not cover common medical services such as dental, vision, and long-term care.Medicare Part A out-of-pocket costs
Medicare Part A (hospital insurance) covers inpatient hospital stays, skilled nursing facility care, hospice care, and other benefits. Out-of-pocket costs associated with Part A include premiums, deductibles, and co-insurance. The first Medicare Part A cost is the premium, although most people do not have to pay it. If you do, it can cost up to $413 per month in 2017. The second and third costs are the deductibles and coinsurance for inpatient hospital stays and skilled nursing facility care. The costs associated with each service are listed below:Hospital stay: deductibles and co-insurance
- $1,216 deductible per benefit period
- First 60 days: No coinsurance
- Days 61-90: $304 coinsurance per day
- Days 90+: $608 coinsurance per “lifetime reserve day”
- Days 90+ if you have no reserve days: Medicare covers nothing
Skilled nursing facility stay: deductibles and co-insurance
- First 20 days: No co-insurance
- Days 21-100: $152 coinsurance per day
- Days 100+: Medicare covers nothing
In 2010, Medicare beneficiaries with one hospitalization spent an average of $4,475 on out-of-pocket medical services per year, whereas those with two or more hospitalizations spent an average of $6,216. Other major costs that burden Medicare beneficiaries are custodial care, long-term care, and end-of-life care.
Medicare Part A provides skilled nursing facility care for those who were recently admitted to the hospital, but it does not provide coverage for long-term care such as extended stays in nursing homes or assisted living facilities. The cost of this care can burden beneficiaries, according to the KFF report. For the small percentage of Medicare beneficiaries who live in long-term care facilities, the average out-of-pocket service costs average $17,534 per year, according to the Henry J. Kaiser Family Association. This large annual cost is for facility expenses, inpatient hospitalizations, and care services.
Medicare Part B out-of-pocket costs
Medicare Part B (medical insurance) covers outpatient hospital care, doctor’s visits, preventative care, and other services. Out-of-pocket costs associated with Part B include premiums, deductibles, coinsurance, and copayments.- The first Medicare Part B cost is the premium. Medicare Part B enrollees pay between $105 and $336 per month for this coverage, depending on their income levels. If you get Social Security, Railroad Retirement Board benefits, or Civil Service benefits, your Medicare Part B premium will be automatically deducted from your benefit payment.
- The second Part B cost is a deductible that you must pay before Part B covers anything. The Part B deductible is $147 in 2015.
- The third out-of-pocket cost under Part B is coinsurance. Medicare Part B covers 80% of the cost of approved medical services. You are responsible for the remaining 20%. For example, if you receive an approved MRI that costs $500, Medicare will pay $400 and you will pay a $100 co-insurance.
- The fourth out-of-pocket cost under Part B is co-payment. If you receive a medical service in a hospital outpatient setting, you may be charged a co-payment. The co-payment amount will vary depending on the service provided. If a service is not classified as “medically necessary” to treat a medical condition, Medicare does not cover it.
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