Medicare

Medicare Planning & Important Medicare Related Links

Medicare 2015

Medicare Part A Medicare Part B
2015 Part A is Hospital Insurance covering costs associated with confinement in a hospital or skilled nursing facility. 2015 Part B is Medical Insurance covering physician services, outpatient care, tests and supplies.
When you are hospitalized for: Medicare Covers Patient Pays On Expenses Incurred for: Medicare Covers Patient Pays
$147 Annual Deductible PLUS
1 – 60 Days Most confinement costs after the required Medicare Deductible. $1,260 Deductible Medical Expenses Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy, diagnostic tests 80% of approved amount 20% of approved amount
61 – 90 Days All eligible expenses after the patient pays a per-day copayment $315 a day copayment Clinical Laboratory Service Blood tests, urinalysis Generally 100% of approved amount Nothing for services
91 – 150 Days All eligible expenses after patient pays a per-day copayment. (Lifetime Reserve Days which may never be used again.) $630 a day copayment Home Health Care Part time or intermittent skilled care, home health aide services, durable medical supplies and other services 100% of approved amount; 80% of approved amount for durable medical equipment Nothing for services; 20% of approved amount for durable medical equipment
151 days or more NOTHING Patient pays all costs. Outpatient Hospital Treatment Hospital services for the diagnosis or treatment of an illness or injury Medicare payment to hospital based on outpatient procedures payment rates Coinsurance based on outpatient payment rates
Skilled Nursing Confinement When you are hospitalized for at least 3 days and enter a Medicare approved skilled nursing facility within 30 days after hospital discharge and are receiving skilled nursing care. All eligible expenses for the first 20 days; then all eligible expenses for days 21 – 100 after the patient pays a per day co-payment After 20 days$157.50 a day copayment Blood After first
3 pints of blood
80%
of approved
amount
First 3 pints of
blood plus 20% of approved
amount for additional
pints
Part B Premium * See Below*
* Premium is per person
On all Medicare-approved expenses, a doctor or other health care provider may agree to accept Medicare “assignment”. This means the patient will not be required to pay any expense in excess of Medicare’s “approved” charge. The patient pays only 20% of the approved charge not paid by Medicare. Physicians who do not accept assignment of a Medicare claim are limited as to the amount they may charge for covered services.

 

                      *2015 Part B Premiums

Annual Income Monthly Premium for 2015*
Single: up to $85,000
Couple: up to $170,000

$104.90

Single: $85,001 to $107,000
Couple: $170,001 to $214,000

$146.90

Single: $107,001 to $160,000
Couple: $214,001 to $320,000

$209.80

Single: $160,001 to $213,000
Couple: $320,001 to $428,000

$272.70

Single: $214,001 and over
Couple: $428,000 and over

$335.70

 

 

                The Standardized Plans

Benefits A B C D F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
Blood (first 3 pints) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Part B deductible No No Yes No Yes No No No No No
Part B excess charges No No No No Yes Yes No No No No
Foreign travel exchange (up to plan limits) No No Yes Yes Yes Yes No No Yes Yes
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $4,940 $2,470 N/A N/A
* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,140 in 2014 ($2,180 in 2015) before your Medigap plan pays anything.** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.