Original Medicare contains Part A and Part B. Below is what you would be responsible for if you had only Part A & Part B.
Part A is Hospital Insurance
Part A is designed to cover costs associated with inpatient Medical treatment including hospital inpatient care, care at a skilled nursing facility, hospice, and home health care.
Inpatient Hospital Deductible for 2023
- $1,600 deductible for each benefit period (60 day benefit period)
- Days 1 – 60 = $0 copay after deductible
- Days 61 – 90 = $400 copay per day
- Days 91 and beyond = $800 copay per each “lifetime reserve day” after 90 each benefit period
- There are up to 60 lifetime reserve days in your lifetime.
Skilled Nursing Facility for 2023
- Days 1 – 20 = $0 copay
- Days 21 – 100 = $200 copay per day
- Note: Medicare only pays for a Skilled Nursing Facility if you have had experienced an inpatient hospitalization stay for at least 3 consecutive days prior.
- After day 100 you are responsible for all charges
Hospice Care for 2023 has $0 copay
Home Health Care for 2023 has $0 copay
- Note: Medicare does not cover 24 hour care at home or custodial care, which is help with activities of daily living.
Is there a cost to have Part A?
No charge to simply carry Part A if you paid into Medicare or married to someone who has paid Medicare taxes while working.
Part B is Medical Insurance
Part B is designed to help cover costs of outpatient medical services. There are many services covered by Part B. Below are common items.
Part B covered services include (but not limited to):
- Doctor office visits
- Outpatient surgeries
- Outpatient therapy (physical therapy, occupational therapy, and more)
- Durable medical equipment
Annual Deductible for 2023 = $226
Medical & Other Services you pay 20% of the Medicare-approved amount.
Premiums for Part B:
In 2023, the base premium to carry Part B is $164.90 monthly per individual.
- Depending on your income limit, there may be assistance available to help pay the Part B premium.
- You may pay more due to what is known as the income-related monthly adjustment amount (IRMAA). Your IRMAA surcharge is based on your modified adjusted gross income reported on your federal tax return from two years ago. See chart below.
- If you have a qualifying life changing event and your income is currently lower than the reporting from 2 years ago, you can appeal the surcharge.
Is there a maximum out-of-pocket limit with Original Medicare?
There is no limit to how much medical bills can add to over a calendar year with Original Medicare- it is smart to choose a Medicare Supplement or a Medicare Advantage Plan.