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Medicare Deductible & Coinsurance Amounts

Medicare helps provide health care coverage to millions of senior citizens in the United States. Original Medicare comes in two parts, called A and B, which provide most of the benefits. Part C, Medicare Advantage, mainly allows beneficiaries to purchase their policies from private companies. But MA plans also may include extra benefits such as hearing, vision and dental. Part D Medicare is for prescription medications. Medicare is not free, however. Each part has its own premiums, copayments, coinsurance rates and deductibles.

  1. Part A

    • Many people receive Part A free of monthly premiums. But Part A also has deductible and coinsurance payments for skilled nursing facility care and hospital stays. Coinsurance is a set amount users must pay for services, while copays are a percentage. The coinsurance for one to 60 days of inpatient hospital care in 2011 had a deductible of $1,132. For days 61 through 90, you pay $283 per day. For stays of 91 through 150 days, your coinsurance is $566 per day. After that, you pay all costs yourself for that benefit period. Stays in a skilled nursing facility cost $141.50 for stays of 21 through 100 days.

    Part B

    • All users must pay a monthly premium for Part B. Your premium may be higher if you have a large income, but the standard monthly premium payment for Part B in 2011 was $115.40 for new enrollees. Part B has an annual deductible as well. In 2011, the deductible was set at $162, although this can change yearly. Most Part B services also require a copayment of 20 percent of the Medicare-approved amount after the annual deductible has been met.

    Medicare Advantage

    • Medicare Advantage plans must offer all the same benefits as Original Medicare, except for hospice care, which is always covered by the government. Companies that sell MA plans are allowed to set their own deductibles, premiums and coinsurance costs, however. Your out-of-pocket costs will depend on where you live, which company you buy from and what kind of plan you purchase. Some MA plans have no monthly premiums at all in exchange for higher coinsurance and copays.

    Part D

    • Part D Medicare offers benefits only for prescription medications. If you already have coverage for prescription drugs through your Medicare Advantage plan, you do not need to buy a stand-alone Part D policy. Since Part D also is sold by private companies, some out-of-pocket costs depend on the company you buy it from. Others are set by Medicare. Part D has an annual maximum deductible, although companies can offer Part D with lower or no deductibles if they so choose. In 2011, the maximum annual Part D deductible was $310.

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