What Out-Of-Pocket Costs Can I Expect With Medicare?

August 31, 2021
out-of-pocket costs with Medicare

You can expect to pay deductibles, copayments, coinsurance, and possibly excess charges for your covered health care services with Medicare.

Looking for ways to save on out-of-pocket costs? Talk to the Medicare experts at Healthcare Solutions Direct.

Deductibles

You will be charged deductibles for both your Medicare Part A and Part B covered expenses. A deductible is the payment amount you have to reach in spending toward your covered healthcare expenses before Medicare will begin to pay for its share of the costs. 

The Part A deductible applies for each benefit period within the year. A benefit period is the time between being admitted as an inpatient in a hospital or skilled nursing facility and when you haven’t received inpatient care for 60 days. You may have to pay multiple Medicare Part A deductibles in the same year if your inpatient stays are spaced far enough apart. The Medicare Part A deductible in 2021 is $1,484 per benefit period.

The Part B deductible works like every other health insurance deductible, charging you one amount on a yearly basis. In 2021, once you have paid $203 toward Part B covered healthcare services, items, or tests, Medicare will pick up its share.

Copayments

For Medicare Part B, you will be charged copayments for covered services once you have paid the deductible. Copayments are 20% of the Medicare-approved amount for the covered service. This Medicare-approved amount is standardized and will be much lower than the 

Coinsurance

Once you have spent a certain number of days as an inpatient in a hospital or skilled nursing facility, Medicare Part A will charge you a daily coinsurance.

As a hospital or mental health facility inpatient, you pay nothing in coinsurance for the first 60 days. Days 61 through 90, you pay $371 each day in coinsurance. After day 90, you pay $742 per day in coinsurance, until you have used your 60 lifetime reserve days. Once you have used your lifetime reserve days, you will owe all costs for each day in the hospital beyond day 90.

As an inpatient in a skilled nursing facility, you pay nothing in coinsurance for the first 20 days. For each day from day 21 through 100, you will owe a daily coinsurance of $185.50. After day 100, you will owe all costs each day.

Excess Charges

Something they may not warn you about when it comes to out-of-pocket expenses are the possible excess charges. Healthcare providers who deal with Medicare have the option to accept Medicare’s payment as full payment or not, based on if they choose to be a participating provider with Medicare. 

If your healthcare provider does not accept the Medicare-approved amount as full payment for the covered services, they can charge you up to 15% more for the service. This additional cost is referred to as Part B excess charges. If you’ve paid your deductible, you would be responsible for the 20% copayment plus the excess charges. If you haven’t reached your deductible yet, you could be charged the full 115% of the Medicare-approved amount.

Have Questions? We Can Help!

At Healthcare Solutions Direct, we understand that having coverage that’s within your budget is very important. That’s why we will discuss with you all your Medicare options and the costs you can expect with each.

To learn more, give us a call today!

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