Patients using covered Part A and Part B services may be subject to deductible and coinsurance requirements. Medicare subtracts an inpatient hospital deductible amount from the amount payable to the hospital for inpatient hospital services it provides in a spell of illness. When a patient gets such services for more than 60 days during a spell of illness, they’re responsible for a coinsurance amount equal to one-fourth of the inpatient hospital deductible for each day of days 61-90 spent in the hospital. A patient has 60 lifetime reserve days of coverage, which they may use after day 90 in a spell of illness. The coinsurance amount for these days is equal to one-half of the inpatient hospital deductible.
A patient is responsible for a coinsurance amount equal to one-eighth of the inpatient hospital deductible per day for days 21-100 of skilled nursing facility (SNF) services provided during a spell of illness.
Most individuals age 65 and older, and many disabled individuals under age 65, have Part A benefits without a premium payment. The Social Security Act states that certain aged and disabled persons who aren’t insured may voluntarily enroll but must pay a monthly premium.
Since 1994, voluntary enrollees may qualify for a reduced premium if they have 30-39 quarters of covered employment. When voluntary enrollment takes place more than 12 months after a person’s initial enrollment period, Medicare adds a 10% penalty for 2 years for every year they could have enrolled, but didn’t enroll in Part A.
Under Part B, all enrollees pay a monthly premium. Most Supplementary Medical Insurance (SMI) services are subject to an annual deductible and coinsurance, which are set by statute. When Part B enrollment takes place more than 12 months after a person’s initial enrollment period, there’s a permanent 10% increase in the premium for each year the patient could have enrolled, but didn’t.
2023 Part A – Hospital Insurance (HI)
- Part A Deductible – $1,600.00
- Part A Coinsurance
- $400.00 a day for days 61-90
- $800.00 a day for days 91-150 (lifetime reserve days)
- $200.00 a day for days 21-100 (SNF coinsurance)
- Part A Base Premium (BP) – $506.00 a month
- Part A BP with 10% surcharge – $556.60 a month
- Part A BP with 45% reduction – $278.00 a month (for those who have 30-39 quarters of
- coverage)
- Part A BP with 45% reduction and 10% surcharge – $305.80 a month
2023 Part B – SMI
- Part B Standard Premium – $164.90 a month
- Part B Deductible – $226.00 a year
- Pro Rata Data Amount
- $154.95 – Month 1
- $71.05 – Month 2
- Coinsurance – 20%
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
About 3Gen
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