Editing Medicare (United States) (section)

==Out-of-pocket costs==
No part of Medicare pays for all of a beneficiary's covered medical costs and many costs and services are not covered at all. The program contains [[insurance premium|premiums]], [[deductible]]s and coinsurance, which the covered individual must [[out-of-pocket expenses|pay out-of-pocket]]. A study published by the [[Kaiser Family Foundation]] in 2008 found the Fee-for-Service Medicare benefit package was less generous than either the typical large employer [[preferred provider organization]] plan or the [[Federal Employees Health Benefits Program]] Standard Option.<ref>{{cite book|first1=Dale|last1=Yamamoto|first2=Tricia|last2=Neuman|first3=Michelle Kitchman|last3=Strollo|title=How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?|publisher=[[Kaiser Family Foundation]]|date=September 2008|url=http://www.kff.org/medicare/upload/7768.pdf}}</ref> Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.

===Premiums===
Most Medicare enrollees do not pay a monthly Part A premium, because they (or a spouse) have had 40 or more 3-month quarters in which they paid [[Federal Insurance Contributions Act]] taxes. The benefit is the same no matter how much or how little the beneficiary paid as long as the minimum number of quarters is reached. Medicare-eligible persons who do not have 40 or more quarters of Medicare-covered employment may buy into Part A for an annual adjusted monthly premium of:

* $248.00 per month (as of 2012)<ref name="healthharbor1">{{cite web |title=Medicare: Big Changes for 2011 |url=http://www.healthharbor.com/medicare/2011-medicare-changes |url-status=dead |archive-url=https://web.archive.org/web/20110523085102/http://www.healthharbor.com/medicare/2011-medicare-changes |archive-date=May 23, 2011 |access-date=January 27, 2011}}</ref> for those with 30–39 quarters of Medicare-covered employment, or
* $451.00 per month (as of 2012)<ref name="healthharbor1"/> for those with fewer than 30 quarters of Medicare-covered employment and who are not otherwise eligible for premium-free Part A coverage.<ref>[http://questions.medicare.gov/app/answers/detail/a_id/2305 Medicare premiums and coinsurance rates for 2011], {{webarchive|url=https://web.archive.org/web/20111015004424/http://questions.medicare.gov/app/answers/detail/a_id/2305|date=October 15, 2011}}, FAQ, Medicare.gov (11/05/2010).</ref>

Most Medicare Part B enrollees pay an [[insurance premium]] for this coverage; the standard Part B premium for 2019 is $135.50 a month. A new income-based premium surtax [[Model (abstract)|schema]] has been in effect since 2007, wherein Part B premiums are higher for beneficiaries with incomes exceeding $85,000 for individuals or $170,000 for married couples. Depending on the extent to which beneficiary earnings exceed the base income, these higher Part B premiums are from 30% to 70% higher with the highest premium paid by individuals earning more than $214,000, or married couples earning more than $428,000.<ref name="2012 Medicare & You">2012 Medicare & You handbook, Centers for Medicare & Medicaid Services.</ref> This extra amount is called the Income Related Monthly Adjustment Amount (IRMAA).

===Deductible and coinsurance===
'''Part A'''—For each [[benefit period]], a beneficiary pays an annually adjusted:

* A Part A deductible of '''$1,632''' in '''2024''' for a hospital stay of 1–60 days.<ref name=":1" />
* A '''$408''' per day co-pay in '''2024''' for days 61–90 of a hospital stay.<ref name=":1" />
* A '''$816''' per day co-pay in '''2024 f'''or days 91–150 of a hospital stay, as part of their limited [[Lifetime Reserve Days]].<ref name=":1" />
* All costs for each day beyond 150 days<ref name="Medicare.gov">{{cite web |date=2017 |title=Medicare 2017 costs at a glance |url=https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html |url-status=dead |archive-url=https://web.archive.org/web/20180910124746/https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html |archive-date=September 10, 2018 |access-date=March 12, 2017 |publisher=Medicare, U.S. Centers for Medicare & Medicaid Services, Baltimore}}</ref>
* Coinsurance for a Skilled Nursing Facility is '''$204''' per day in 2024 for days 21100 for each benefit period (no co-pay for the first 20 days).<ref name=":1" />
* A blood deductible of the first 3 pints of blood needed in a calendar year, unless replaced. There is a 3-pint blood deductible for both Part A and Part B, and these separate deductibles do not overlap.

'''Part B'''—After beneficiaries meet the yearly deductible of '''$240''' for 2024, they will be required to pay a co-insurance of 20% of the Medicare-approved amount for all services covered by Part B<ref name=":1" /> with the exception of most lab services, which are covered at 100%. Previously, outpatient mental health services was covered at 50%, but under the [[Medicare Improvements for Patients and Providers Act of 2008]], it gradually decreased over several years and now matches the 20% required for other services.<ref>{{Cite web|title=Medicare Coverage of Mental Health Services |publisher=Center for Medicare Advocacy|date=May 29, 2009 |url=https://www.medicareadvocacy.org/medical-coverage-of-mental-health-services/}}</ref> They are also required to pay an excess charge of 15% for services rendered by physicians who do not accept assignment.

The deductibles, co-pays, and coinsurance charges for Part C and D plans vary from plan to plan. All Part C plans include an annual out-of-pocket (OOP) upper spend limit. Original Medicare does not include an OOP limit.

===Medicare supplement (Medigap) policies===
{{Main|Medigap}}{{More citations needed|date=May 2020}}

All insurance companies that sell Medigap policies are required to make Plan A available, and if they offer any other policies, they must also make either Plan C available as well. Plan F is no longer offered as of 2020, but anyone who has a Plan F may keep it.<ref>{{cite web |title=How to compare Medigap policies|url=https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies |website=Medicare.gov |access-date=13 March 2020}}</ref> Many of the insurance companies that offer Medigap insurance policies also sponsor Part C health plans, but most Part C health plans are sponsored by integrated health delivery systems and their spin-offs, charities, and unions as opposed to insurance companies.{{Citation needed|date=March 2025}}