Medicare A and B Cost and Benefits 2013

Medicare monthly premiums

Medicare Part A (Hospital Insurance)
Monthly premium (for people who pay a premium): If you buy Part A, you’ll pay up to $441 each month in 2013. Higher-income consumers may pay more.
Late enrollment penalty: If you don’t buy it when you’re first eligible, your monthly premium may go up 10%. (You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.)

Medicare Part B (Medical Insurance)
Monthly premium: Most people pay the Part B premium of $104.90 each month in 2013.
Late enrollment penalty: If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

Medicare Part C (Medicare Advantage)
Monthly premium: The Part C monthly premium varies by plan.

Medicare Part D (Medicare prescription drug coverage)
Monthly premium: The Part D monthly premium varies by plan (higher-income consumers may pay more).
Late enrollment penalty: The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.

 

What you pay for medical care if you have Original Medicare

 Medicare Part A (Hospital Insurance) costs

Home health care

$0 for home health care services.
20% of the Medicare-approved amount for durable medical equipment.

Hospice care

$0 for hospice care.
You may need to pay a copayment of no more than $5 for each prescription drug and other similar product for pain relief and symptom control.
You may need to pay 5% of the Medicare-approved amount for inpatient respite care. Your cost for respite care may range from $5-$12 per day.
Your usual Part B deductible and coinsurance for your doctor’s services (if your attending doctor isn’t employed by the hospice).
Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
If you pay out-of-pocket for an item or service your doctor ordered, but the hospice refuses to give you, you can file a claim with Medicare. If your claim is denied, you may file an appeal.

Hospital inpatient stay

You pay:
Days 1–60: $1,184 deductible for each benefit period in 2013.
Days 61–90: $296 coinsurance per day of each benefit period in 2013.
Days 91 and beyond: $592 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) in 2013.
Beyond lifetime reserve days: all costs.

Note:

You pay for private-duty nursing, a television, or a phone in your room. You pay for a private room unless it’s medically necessary.

Mental health inpatient stay

You pay:
Days 1–60: $1,184 deductible for each benefit period in 2013.
Days 61–90: $296 coinsurance per day of each benefit period in 2013.
Days 91 and beyond: $592 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) in 2013.
Beyond lifetime reserve days: all costs.

Note:

There’s no limit to the number of benefit periods you can have when you get mental health care in a general hospital. You can also have multiple benefit periods when you get care in a psychiatric hospital. Remember, there’s a lifetime limit of 190 days.
20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.

Skilled nursing facility stay

$0 for the first 20 days each benefit period.
$148 per day for days 21-100 each benefit period in 2013.
All costs for each day after day 100 in a benefit period.

Note:

If you’re in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those noted above. Review the “Evidence of Coverage” from your plan.

 Medicare Part B (Medical Insurance) costs

Part B annual deductible

You pay $147 per year for your Part B deductible in 2013.

Part B monthly premium

You pay a Medicare Part B (Medical Insurance) premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

Numbers below are for 2011 tax returns:  This is what would be paid in 2013:  Single and joint returns listed:

$85,000 or less for single return:  $170,000 or less for joint return:  $104.90 month each
above $85,000 up to $107,000 single return:  above $170,000 up to $214,000 for joint return: $146.90 a month each
above $107,000 up to $160,000 single return: above $214,000 up to $320,000 for joint return:  $209.80 a month each
above $160,000 up to $214,000 single return: above $320,000 up to $428,000 for joint return $272.70 a month each
above $214,000 single return:  above $428,000 joint return:  $335.70 a month each

To get more information about your Part B premium, contact Social Security.

Clinical laboratory services

You pay $0 for Medicare-approved services.

Home health services

You pay:
$0 for home health care services.
20% of the Medicare-approved amount for durable medical equipment.

Medical and other services

You pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment.

Outpatient mental health services

You pay:
20% of the Medicare-approved amount for visits to a doctor or other health care provider to diagnose your condition or to monitor or change your prescriptions. The Part B deductible applies.
If you get treatment in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount of the hospital. This amount will vary depending on the service provided, but will be between 20-40% of the Medicare-approved amount.
35% of the Medicare-approved amount for outpatient treatment of your condition (like individual or group psychotherapy) in a doctor or other health provider’s office or hospital outpatient department.

Partial hospitalization mental health services

You pay a percentage of the Medicare-approved amount for each service you get from a doctor or certain other mental health qualified professional. You also pay a copayment for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B deductible applies.

Note:

In 2013, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.

All Medicare Advantage Plans must cover these services. If you’re in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those noted above. Review the “Evidence of Coverage” from your plan.

Outpatient hospital services

You generally pay 20% of the Medicare-approved amount for the doctor or other health care provider’s services, and the Part B deductible applies.
For all other services, you also generally pay a copayment for each service you get in an outpatient hospital setting. You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor’s office.
For some screenings and preventive services, coinsurance, copayments, and the Part B deductible don’t apply (so you pay nothing).

 Medicare prescription drug coverage (Part D) costs

Plan premiums vary by company:  There is NOT a plan offered by Medicare.  They are all offered by private insurance companies.  Based on 2011 returns for 2013.  Single and joint returns listed

 

single $85,000 or less: joint $170,000 or less Your plan premium
single above $85,000 up to $107,000:  joint above $170,000 up to $214,000 $11.60 + your plan premium
single above $107,000 up to $160,000:  joint above $214,000 up to $320,000 $29.90 + your plan premium
single above $160,000 up to $214,000: joint above $320,000 up to $428,000 $48.30 + your plan premium
single above $214,000: joint above $428,000 $66.60 + your plan premium

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