Part A - Out-of-pocket Costs

Out-of-pocket costs include premiums, deductibles and copays/coinsurance for covered services. These costs for Part A are outlined below.

Part A - Out-of-pocket Costs

PART A (Hospital Insurance) – Out-of-pocket Costs

You may qualify for premium-free Part A coverage (most people do) if you or your spouse has paid Medicare taxes, while employed, for at least 40 quarters. Otherwise, you will have to pay up to $437 as monthly premium for Part A services, based on the number of quarters during which you or your spouse paid Medicare taxes.

You may also be assessed penalties for delayed enrollment in Part A. Ensure that you enroll in time or have equivalent coverage from other sources, e.g. a group health insurance plan, enabling you to ‘defer' Part A until the time you lose the equivalent coverage.

The table below summarizes Part A out-of-pocket costs for care at various types of facilities.

Description

 

Your Costs (during 2019)

 

 

 

Inpatient care at a hospital

  • $1,364 deductible per ‘benefit period’
  • $0 copay for days 1-60 for each benefit period
  • $341 copay per day for days 61-90 during each benefit period
  • $682 copay per day for ‘lifetime reserve days’ beyond day 90
  • All costs after you have used up ‘lifetime reserve days’ (currently limited to 60 such days)

 

 

 

Skilled nursing facility (SNF)

  • $0 for the first 20 days each ‘benefit period’
  • $170.50 per day for days 21-100 each ‘benefit period’
  • All costs after 100 days

 

 

 

Home health care

 

 

 

  • $0 for home health care services (fully covered by Medicare)
  • 20% of the Medicare approved amount as coinsurance for medical equipment

 

 

 

 

Hospice care

  • You generally pay very little for hospice care
  • Copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management
  • 5% of Medicare approved amount for inpatient respite care as coinsurance

 

 

                                                                                                                                                  

Click here to learn more about Medicare, its various Parts, different enrollment periods and your costs. 

We have also created videos to help you better understand various topics related to Medicare. Select and watch a video explaining the topic of your interest in a simple and intuitive manner.

Remember that you cannot choose just any combination of Parts and Plans. Let Lighted Road Insurance guide you step-by-step through the Medicare ecosystem and help you in selecting the right plan(s) for your needs.