Summary of Medicare Benefits and Cost-Sharing for 2009
The chart below is a comprehensive list of Medicare Part A and B costs, including premiums, deductibles and coinsurance. Medicare supplemental insurance, known as Medigap, can help cover some of the gaps in coverage and pay for part or all of Medicare's coinsurance and deductibles, depending on the policy. Some Medicare Advantage (MA) plans may also help cover these costs. See Medigap: Medicare Supplemental Insurance and Medicare Advantage for more information.
Comprehensive Part A (Hospital Insurance) Costs
| If You Have | In 2009, You Will Pay a Monthly Premium of | |
|---|---|---|
| 0-29 quarters of Social Security credits | $443 | |
| 30–39 quarters of Social Security credits | $244 | |
| 40 or more quarters of Social Security credits | $0 | |
| Inpatient Hospital Deductible | $1,068 | |
| Inpatient Hospital Coinsurance | $267 per day for days 61–90 $534 per day for days 91-150 |
|
| Skilled Nursing Facility Coinsurance | $133.50 per day for days 21-100 | |
| Service Provided | Medicare Pays | You Pay |
| Hospital Inpatient | ||
| Days 1-60 | 100% after deductible | $1,068 deductible |
| Days 61-90 | 100% after copayment | $267 per day copayment |
| 60 Reserve Days1 | 100% after copayment | $534 per day copayment |
| After 150 Days | 0% | 100% for each day |
| Psychiatric Hospital | Same as hospital inpatient (see above) with a 190-day lifetime limit | 100% after 190 days |
| Skilled Nursing Facility (SNF) (if daily skilled care is needed after a 3-day hospital stay) |
||
| Days 1-20 | 100% | 0% |
| Days 21-100 | 100% after copayment | $133.50 per day copayment |
| After 100 Days | 0% | 100% |
| Home Health Care | 100% minus 20% of covered medical equipment | 20% of Medicare-approved amount for medical equipment |
| Hospice Care | 100% minus $5 per prescription; 95% of Medicare-approved payment for respite care per day | Copayment of $5 per prescription; 5% of Medicare-approved payment for respite care per day, not to exceed $1,068 |
| Blood (received during hospital or SNF stay) | 100% after first 3 pints of blood | First 3 pints of blood each year |
1 Each of the 60 reserve days may be used only once during an individual's lifetime.
Comprehensive Part B (Medical Insurance) Costs
| Your Annual Income | Your Monthly Premium For 2009 | |
|---|---|---|
|
$96.40 | |
|
$134.90 | |
|
$192.70 | |
|
$250.50 | |
|
$308.30 | |
| Service | Medicare Pays | You Pay |
| Annual Deductible | $135/year | |
| Physician Costs | 80% of approved amount | 20% of Medicare-approved amount, plus up to an additional 15% of the approved amount if the doctor or supplier does not accept assignment |
| Outpatient Hospital Care | 80% of approved amount | $1,068 maximum |
| Clinical Lab Services | Approved amount | $0 |
| Medical Equipment/Supplies | 80% of approved amount | All other costs |
| Certain Preventive Services (depending on the service, some are covered at certain intervals, such as once per year) | 80% or 100% | 20% of approved amount or $0, depending on the service |
| Mental Health Services Partial Hospitalization |
Days 1-60: 100% after deductible Days 61-90: 100% after copayment 60 Reserve Days1: 100% after copayment After 150 Days: 0% |
Days 1-60: $1,068 deductible Days 61-90: $267 per day copayment 60 Reserve Days1: $534 per day copayment After 150 Days: 100% for each day |
| Outpatient | 50% of approved amount | 50% of approved amount |
1 Each of the 60 reserve days may be used only once during an individual's lifetime.
