Medicare deductibles and copayments are the out-of-pocket expenses that either you or a supplemental insurance plan pays for Part A and Part B hospital and medical care. Although both are subject to change on January 1 of each year, they do not always change every year. The Centers for Medicare and Medicaid Services publishes current information on the Medicare.gov website.
Part A and Part B Deductibles
Part A and Part B deductibles are the amounts you pay for health care services before your Medicare insurance plan begins paying. As of publication, the deductible for Part A hospital insurance is $1,260 for each benefit period -- a 60-day period that begins on the day you’re admitted to a hospital or a skilled nursing facility -- and $147 per year for Part B medical insurance. Although you pay the full cost for most health care services until you meet the deductible for each benefit period or the annual limit, Medicare does cover some services before you meet the deductible.
Part A and Part B Copayments
Copayments apply only after you meet deductible limits and Medicare starts paying. A co-pay is a fixed amount that you pay every time you visit a doctor or receive a medical service. For example, if you fill a prescription for pain management under Medicare Part A hospice care, there’s a co-pay of up to $5 as of publication, depending on the type of medication. Although many Part B services also require copayments, these vary according to the facility or doctor. Contact Medicare at 1-800-633-4227 or the facility for the most current information.
Copayments vs. Coinsurance
Medicare Part A also charges coinsurance fees to hospital and skilled nursing facility inpatients. These are a type of copayment but are significantly higher. The fees also apply during each benefit period and only kick in if your hospital stay exceeds 60 days or your skilled nursing facility stay exceeds 20 days. As of publication, hospital stays between 61and 90 days have a $315 per-day coinsurance fee and skilled nursing facility stays between 21 and 100 days have a $157.50 coinsurance fee.
Lifetime Reserve Maximums
Medicare hospitalization coverage technically ends after 90 days. However, you have the option to extend coverage for up to 60 additional days for costs that exceed a $630 per day coinsurance payment. The 60-day period, known as your lifetime reserve, can be used at one time or in smaller increments. However, once you hit the 60-day limit, you become 100 percent responsible for any further hospitalization expenses. Lifetime reserve days do not apply to skilled nursing facilities.