Medicare A & B Guide

An overview of Medicare Part A

Medicare Part A insurance helps pay for medically necessary care—care for an illness or medical condition—that involves an inpatient stay in the hospital. Part A also helps pay for a stay in a skilled nursing facility as a follow-up to a hospital stay, hospice care for the terminally ill and some skilled home health care for those who cannot leave their homes. And it helps pay for some blood transfusions.

What providers can you see?

You can choose any qualified provider in the United States who has been accepted by Medicare and who is accepting new patients. Because Part A offers the same benefits throughout the United States, you are not limited to a particular state or region for your care.

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Medicare Costs

Premium

Part A is free if you or your spouse made payroll contributions to Social Security for at least 10 years (40 quarters).

If you otherwise qualify for Medicare but neither you nor your spouse contributed to Social Security for at least 10 years, you’ll pay a monthly premiums of up to $450 per month in 2011.

Important: If you don’t qualify for no-premium Part A benefits, and you don’t enroll in Part A when you first become eligible for Medicare, your Part A premium could be higher.

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Medicare Cost sharing

Deductible

Before Part A begins paying a share of your costs, you must first pay a deductible. In 2011, your Part A deductible is $1,132. You’ll pay this deductible for each hospital stay, subject to certain limits.

Medicare Copay

You pay a copay  after you have stayed in the hospital or in a skilled nursing facility a certain number of days. Here are the Part A copays for 2011:

  • For hospital stays, you’ll pay $283 per day for days 61 through 90, and $566 per day for days 91 through 150.
  • In a skilled nursing facility, you’ll pay $141.50 for days 21 through 100 that you stay.
  • You’ll also pay a copay of $5 for each outpatient drug prescription you receive in hospice care.

Medicare Coinsurance

You will pay a small coinsurance payment if you use inpatient respite care for hospice patients.

 

 

An overview of Medicare Part B

 

Medicare Part B insurance helps pay for a variety of medically necessary care—that is, care for an illness or medical condition. This includes services like doctor’s office visits, care in hospitals and clinics when you are not admitted for an inpatient stay, laboratory tests and some diagnostic screenings, and some skilled nursing care at home if you cannot leave your home.

Part B also covers most doctor services you receive as a hospital inpatient, although other hospital services are covered by Part A. Unlike Part A, Medicare Part B is voluntary, but most people sign up when they first become eligible.

In 2011, Medicare Part B is making it easier to get preventive care. It will now cover an annual physical exam plus additional preventive screenings at no cost to you.

 

What providers can you see with Medicare Part B?

You can choose any provider who is eligible to participate in Medicare and who is accepting new patients.

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Medicare Part B Costs

Medicare Part B Premium

Most people pay a monthly premium for Medicare Part B. The premium amount depends on your yearly income. If you receive Social Security, the premium will be automatically deducted from your Social Security benefits. For 2011, premiums range from $115.40 to $369.10 per month.

 

Important: You may pay a penalty if you don’t sign up for Part B when you are first eligible. Your cost for Medicare Part B may go up 10% for each full 12-month period that you could have had Part B but didn’t sign up for it. You’ll pay that penalty for as long as you’re enrolled in Part B.

This penalty may not apply to you if you are still working for an employer who provides group health coverage or if you have other credible coverage when you become eligible for Medicare.

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Medicare Part B Cost sharing

Medicare Part B Deductible

Before Part B begins paying a share of your costs, you must first pay a deductible once a year. In 2011, your deductible is $162 for the year.

 

Medicare Part B Copay

Outpatient hospital services have copays that can range from a few dollars up to $1,132 (in 2011).

 

Medicare Part B Coinsurance

After you pay your deductible,  Medicare Part B shares the cost of your care with you. Part B generally pays 80% and you pay 20% as coinsurance.

In Part B, you’ll pay a share of the cost of your care as you receive it. You’ll pay the same share whether you need a little care or a lot.