Out of Pocket Costs with Medicare Part A


Medicare Part A is your Hospital coverage under Medicare. This is the part that will pay if you are ever an inpatient in a hospital or skilled nursing facility.

Each time you are admitted to the hospital, you will have out of pocket costs. These are good things to be aware of. REMEMBER, these are the costs that you will have without any additional insurance. This is Medicare Part A by itself.

Generally speaking, the government will make changes to Medicare in some form each year. The costs that are depicted in this post are for 2018.

Each each hospital admission will have a deductible. In 2018 the deductible is $1340. Because Medicare by itself doesn't have a Maximum Out Of Pocket limit, each time you are admitted, you will pay the deductible.

The deductible will cover you for days 1 - 60. If you happen to be in the hospital for more than 60 days, you will start to have a daily copay. For days 61-90, the daily copay is $335.

After 90 days in the hospital, Medicare will start to take from a Lifetime Benefit Pool of Reserve Days that you are given. Each Medicare Beneficiary is given 60 Lifetime Reserve Days. Once you use one of these days, it is gone forever. If you happen to use one of these days, the daily copay will go up. In the time I have been an insurance agent, the number has traditionally doubled from the previous daily copay. In 2018, if you use a Lifetime Reserve Day, you will pay a copay of $670/day.

Anything beyond the Reserve Days, Medicare will no longer pay. Medicare is designed for Acute Recovery Care. This means you are showing signs of improvement or in other words, you are getting better. Once you start to show signs that you are not getting better, Medicare can pull the plug on paying bills. That can even happen BEFORE the maximum number of days have been met.

Medicare does not pay for Long Term Care. So if you happen to run into a situation where you will need Long Term Care, Medicare will no longer pay for your stay in a hospital.

Now on the flip side, let's say you are admitted to the hospital with an injury. You have a hospital stay of 3 days or more and they want to transition you to a Skilled Nursing Facility, or Rehabilitation Center. As long as you have been an inpatient in the hospital for 3 days, you can transition to a skilled nursing facility and Medicare Part A will pay.

The first 20 days in the skilled nursing facility are covered at no additional cost. However, days 21-100 will have a daily copay of $167.50.

After day 100, Medicare will no longer pay because again, this will start to look like Long Term Care and Medicare doesn't cover Long Term Care.

I know this can get a little crazy and scary. Please contact me with questions and ways to help augment the out of pocket costs you will be responsible for if you do not have any other insurance.

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