October 19, 2021

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Medicare Deductibles – How and When Do You Pay Them (our Pro Tips)

4 min read

What is a Medicare Deductible?
Medicare deductibles are the amount of money you will pay out of your own pocket before your benefits kick in. This is the money you pay up front. This video explains how and when you pay your Medicare deductibles.

In 2019, the Medicare Part B deductible is $185. You only have to meet it once in each calendar year. Unless you have a Medigap plan that covers your Part B deductible, Medicare Part B will not pay for your outpatient health care services until after you’ve paid $185 out of your own pocket.

The Medicare Part A deductible works a bit differently. It applies to each different “benefit period” in which you get covered Part A services. A benefit period begins the day you are admitted to the hospital. It ends when you have gone 60 full days without any covered inpatient hospital or skilled nursing facility care.

Benefit periods aren’t connected to a calendar year. You can have several different benefit periods in a single year. There is also no limit to how long a benefit period can be. In 2019, under Part A, you must pay a $1,364 deductible for each benefit period.

Here’s an example of how that might look in real life:

Let’s say you were admitted to the hospital on March 1st and got discharged on March 9th. Your benefit period would begin on March 1st and would end on May 9th. As long as you weren’t admitted to the hospital or a skilled nursing facility in the interim, and you would pay for your Part A deductible once.

If you were readmitted to the hospital on May 1st, you would still be within the original benefit period. Therefore, you would not have to pay the Part A deductible again for that admission because it occurred within 60 days of your discharge.

However, if you were admitted on May 10th, you would start a new benefit period. Then you would be responsible for another Part A deductible because 60 days would have elapsed between your discharge and readmission.

Some Medicare Advantage and Part D Prescription Drug Plans also have annual deductibles. These are amounts you must pay out of pocket before your plan pays for your care. It’s common to see deductibles that apply if you use out-of-network care.

Now it’s important to understand that Medicare has several types of cost-sharing and your Medicare deductibles are just one piece of that. You also have coinsurance and copays that you will pay as you use your Medicare coverage.

What is Medicare Coinsurance?
Coinsurance is your share of a covered health care expense and it is usually expressed as a percentage. For example, under Part B, Medicare typically pays 80% of covered charges and you pay 20% of the Medicare allowable amount for that service.

Part A coinsurance is a fixed dollar amount for covered inpatient days. You pay nothing for the first 60 days in a benefit period. You then begin to pay expensive daily copays on Day 61 until you’ve exhausted your lifetime reserve days at 150 days. (You’ll get 60 lifetime reserve days over the course of your life). After you use those days up, you pay the full cost of your inpatient care.

A Medigap plan, however, will give 365 additional days of coverage in the hospital.medicare deductible

What is Medicare Coinsurance?
Coinsurance is your share of a covered health care expense and it is usually expressed as a percentage. For example, under Part B, Medicare typically pays 80% of covered charges and you pay 20% of the Medicare allowable amount for that service.

Part A coinsurance is a fixed dollar amount for covered inpatient days. You pay nothing for the first 60 days in a benefit period. You then pay $329 per day for days 61 through 90, and $658 per day from day 91 until you’ve exhausted your lifetime reserve days. (You’ll get 60 lifetime reserve days over the course of your life). After you use those days up, you pay the full cost of your inpatient care.

A Medigap plan, however, will give 365 additional days of coverage in the hospital.

Boomer Benefits provides free claims support for life for all of our Medigap and Medicare Advantage policyholders so that you are never alone in dealing with Medicare.

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