Medicare hospital insurance works differently than most other insurance. One of the biggest differences is in how they determine your deductible. A deductible is how much you are expected to pay before your insurance begins to pay. You will owe the full cost for medical services until the total reaches that set amount of the deductible. How much you pay after your insurance coverage kicks in depends on the terms of your policy: with Medicare, the standard cost-sharing is 20 percent of the Medicare-approved amount for covered services.
Part A
Medicare Part A, hospital insurance, defines your time spent in the hospital as specific benefit periods. A benefit period begins when you are admitted as an inpatient in a hospital or skilled nursing facility, and ends when you have not received inpatient care for 60 days. In 2021, you will pay a deductible of $1,484 for each benefit period. There is no limit on the number of benefit periods in a year. With the average hospital stay lasting less than a week, there is potential for multiple benefits within a single year, meaning you will have to pay $1,484 more than once in a twelve-month period.
Part B
Medicare Part B has a deductible of $203 for 2021. You will owe 100 percent of eligible expenses until you have paid $203. Once you have paid the yearly deductible, you will only owe a portion of your expenses for your medical care. Medicare will bill you 20 percent of the Medicare-approved amount for doctor services and items. These Medicare-approved amounts are often lower than what the physician charges, and are standardized for Medicare-covered services. You may also be charged copayments for doctor visits and emergency room visits. Common charges are up to $20 for doctor visits and up to $50 for emergency room visits.
Medicare covers certain preventive services in full, without applying the deductible. All insurance companies are obligated to provide set services free of charge to their members. You are not charged a copayment or coinsurance toward these costs, even if you have not yet met your yearly deductible. Many of these are screenings, vaccines, and counseling for certain conditions. Screenings include tests for blood pressure, cholesterol, depression, diabetes, lung cancer, obesity, and tuberculosis. These services are only free when delivered by a doctor or provider in your plan’s network, or a participating provider who accepts Medicare.
For more information regarding the costs associated with Medicare, give us a call today.