When it comes to Original Medicare (Part A, Part B, and Part D), the potential for high out-of-pocket costs—especially for hospitalization, post-care services, or serious illnesses—can be significant. Here’s a general overview of these costs:

Medicare Part A: Hospital Inpatient Coverage

Medicare Part A covers hospital stays but comes with certain cost-sharing responsibilities within each benefit period (typically a 12-month cycle). Here’s what to expect:

• Deductible: You will pay a deductible for each benefit period before Medicare begins to cover your hospital stay.

• Days 1–60: After the deductible, no coinsurance is required for the first 60 days of your hospital stay.

• Days 61–90: You will be responsible for a daily coinsurance amount for your stay.

• Days 91–150: After 90 days, you can use your lifetime reserve days (up to 60 days) with a higher daily coinsurance. Once these are exhausted, you are responsible for all costs.

For Skilled Nursing Facility Care, after a qualifying hospital stay:

• First 20 days: No coinsurance.

• Days 21–100: Daily coinsurance applies.

• After 100 days: You are responsible for all costs.

If you are readmitted to the hospital within 60 days of discharge, your stay will count toward the same benefit period, meaning no new deductible would be required.

Medicare Part B: Outpatient and Medical Services

Medicare Part B helps cover a variety of medically necessary services, including doctor visits, outpatient care, diagnostic tests, and preventive services. Your cost-sharing for Part B includes:

• Annual Deductible: You must meet an annual deductible before Medicare begins paying its share.

• Coinsurance: Typically, you will pay 20% of the Medicare-approved amount for most services, while Medicare covers the remaining 80%.

If your doctor accepts assignment (agrees to the Medicare-approved amount), you won’t be charged more than the 20% coinsurance. However, if your doctor does not accept assignment, they may charge up to 15% more than the Medicare-approved amount, known as an excess charge.

Note: There is no cap on out-of-pocket costs for services under Part B, meaning if you need significant or ongoing medical care, your costs could be substantial.

Medicare Part D: Prescription Drug Coverage

Medicare Part D covers prescription drugs and is offered through private insurers approved by Medicare. These plans vary in terms of costs, formularies (lists of covered drugs), and pharmacy networks. Key points to consider include:

• Premiums and Deductibles: These vary depending on the plan and may be affected by income-related adjustments.

• Formularies and Networks: Each plan has its own list of covered drugs and may have preferred and non-preferred pharmacy networks, which can affect your out-of-pocket costs.

Medicare sets guidelines for the types of drugs that must be covered and the minimum standards for each plan, but costs and specific coverage details will differ based on the plan you select.

Summary

Original Medicare provides comprehensive coverage but comes with cost-sharing responsibilities that can add up, particularly for hospitalization, long-term care, or chronic conditions. There is no out-of-pocket maximum for Part A or Part B, meaning costs could be unpredictable if significant medical care is required.

To help cover these gaps, many beneficiaries consider adding a Medicare Supplement (Medigap) plan or choosing a Medicare Advantage plan to better manage potential costs.

For more information about how to manage Medicare costs or to explore additional coverage options for 2024 and 2025, contact us today for personalized assistance!