What is my cost sharing with Medicare for 2013?

Changes to Medicare for 2013

Below is an overview of what the Medicare beneficiary is responsible for paying if they have only original Medicare Part A and Part B, with noted increases for 2013.

Is my Medicare cost sharing going up in 2013?

In a prior post the increases in original Medicare Part A (hospital) and Part B (doctor or medical) premiums for 2013 were discussed. You may be wondering if there are additional increases in Medicare-related costs 2013, especially if you do not have a Medicare Supplement or Medicare Advantage plan to help offset the cost-sharing that of original Medicare Part A and Part B. The out-of-pocket costs associated with original Medicare Part A and Part B premiums and deductibles and their increases were discussed in a prior post.

With that being said, if you are wondering if there are increases in the amount of cost-sharing involved with original Medicare Part A and Part B in 2013 for Medicare approved hospitalization or Medicare approved physician office visits or other treatment, the following is a general overview of what the Medicare beneficiary is responsible for paying out-of-pocket if he or she only has original Medicare Part A and Part B, with increases for 2013 noted.

Medicare Part A (hospital) costs include:

Blood – In most cases, the hospital gets blood from a blood bank at no charge, and you will not have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated. However, you will pay a co-payment for the blood processing and handling services for every unit of blood you get, and the original Medicare Part B deductible applies.

Home health care – $0 for home health care services; 20% of the Medicare approved amount for durable medical equipment.

Hospice care – $0 for hospice care and there is no deductible; co-payment of up to $5.00 per prescription for outpatient prescription drugs for pain and symptom management; 5% of the Medicare approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest); your usual original Medicare Part B deductible and coinsurance for your doctor’s services (if your attending doctor is not employed by the hospice). Medicare does not cover room and board when you get hospice care in your home or another facility where you live, such as a nursing home.

In you are hospitalized, which is considered hospital inpatient stay, and you only have original Medicare, you will pay the following:

  • Days 1 through 60: a $1,156.00 deductible for each benefit period in 2012 ($1,184.00 in 2013).
  • Days 61 through 90: a $289.00 coinsurance per day of each benefit period in 2012 ($296.00 in 2013).
  • Days 91 and beyond: a $578 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) in 2012 ($592.00 coinsurance in 2013).
  • Beyond lifetime reserve days: you pay all costs.

If you are hospitalized in a mental health facility for inpatient treatment and you only have original Medicare, you will pay the following:

  • Days 1 through 60: a $1,156.00 deductible for each benefit period in 2012 ($1,184.00 in 2013).
  • Days 61 through 90: a $289.00 coinsurance per day of each benefit period in 2012 ($296.00 in 2013).
  • Days 91 and beyond: a $578.00 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) in 2012 ($592.00 in 2013).

Beyond lifetime reserve days: you pay all costs.

There is no limit to the number of benefit periods you can have when you get mental health care in a general hospital. You can also have multiple benefit periods when you get care in a psychiatric hospital. Remember, there is a lifetime limit of 190 days.

Additionally, with regard to an inpatient mental health treatment period you will pay 20% of the Medicare approved amount for mental health services you get from doctors and other providers while you are a hospital inpatient.

With regard to Skilled Nursing Facility (also known as “SNF”) inpatient stays if you only have original Medicare, you will pay:

  • Days 1 through 20 in each benefit period – $0 co-pay.
  • Days 21 through 100 of each benefit period – $144.50 per day in 2012 ($148.00 in 2013).

Each day after day 100: you pay all costs.

Clinical laboratory services: $0 for Medicare approved services.

With regard to home health services, if you only have original Medicare, you will be responsible for paying the following: $0 for home health care services.

20% of the Medicare-approved amount for durable medical equipment.

With regard to medical and other services, if you only have original Medicare Part A and Part B, you will be responsible for paying the following:

20% of the Medicare approved amount for most doctor services (including most doctor services while you are a hospital inpatient), outpatient therapy, and durable medical equipment.

With regard to outpatient mental health services, if you only have original Medicare Part A and Part B, you will be responsible for paying the following:

20% of the Medicare approved amount for visits to a doctor or other health care provider to diagnose his or her condition or to monitor or change your prescriptions.

40% of the Medicare approved amount for outpatient treatment of the Medicare beneficiary’s condition (such as counseling or psychotherapy) in a doctor’s office setting in 2012 (35% in 2013). In a hospital outpatient setting, the Medicare beneficiary pays a copayment.

With regard to partial hospitalization mental health services, if you only have original Medicare Part A and Part B you will be responsible for paying the following:

40% of the Medicare approved amount for each service you get from a qualified professional, and 20% of the Medicare approved amount for each day of service you get in a hospital outpatient department or a community mental health center.

With regard to outpatient hospital services if you only have original Medicare Part A and Part B then you will be responsible for paying the following:

20% of the Medicare approved amount for the doctor’s services.

For all other services, a copayment for each service you get in an outpatient hospital setting.

For some screenings and preventive services, these charges and the original Medicare Part B deductible do not apply.

 

It is important that you understand what out-of-pocket costs you will be responsible for paying and any increases that will be applied in 2013. While the Annual Election Period is over, there still may be options available to you to help assist with the out-of-pocket costs original Medicare leaves you responsible for paying. Contact a Medicare Pathways Benefit Specialist today to discuss options available and to determine if you qualify for a Special Enrollment Period to enroll in a Medicare Advantage Plan or to determine if you qualify for a Medicare Supplement plan. Medicare Pathways is available to assist you all year, not just during the Annual Election Period.

 

Medicare Pathways, Inc.  1-866-466-9118

 

 

 

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