Medicare Copays announced for 2016

2016 MEDICARE PART A

 

Part A is Hospital Insurance and covers costs associated with confinement in a hospital or skilled nursing facility.

 

WHEN YOU ARE HOSPITALIZED FOR: MEDICARE COVERS  

YOU PAY

 

1-60 DAYS

 

Most confinement costs after the required Medicare deductible

$1,288

DEDUCTIBLE

 

 

61-90 DAYS

 

All eligible expenses after patient pays a

per-day copayment

$322 A DAY

COPAYMENT as much as:

$9,660

 

 

91-150 DAYS

All eligible expenses after patient pays a

per-day copayment (These are Lifetime Reserve Days that may never be used again)

$644 A DAY

COPAYMENT as much as:

$38,640

151 DAYS OR MORE  

NOTHING

YOU PAY ALL COSTS
SKILLED NURSING CONFINEMENT:

Following an inpatient hospital stay of at least 3 days and enter a Medicare-approved skilled nursing facility within 30 days after hospital discharge and receive

skilled nursing care

 

 

All eligible expenses for the first 20 days; then all eligible expenses for days 21-100 after patient pays a per-day copayment

 

 

After 20 days

$161 A DAY

COPAYMENT as much as:

$12,880

 

2016 MEDICARE PART B

 

Part B is Medical Insurance and covers physician services, outpatient care, tests, and supplies.

 

ON EXPENSES INCURRED FOR:  

MEDICARE COVERS

 

YOU PAY

ANNUAL DEDUCTIBLE Incurred Expenses after the required Medicare deductible  

$166 Annual Deductible

MEDICAL EXPENSES

Physicians’ services for inpatient and outpatient medical/surgical services; physical/speech therapy; and diagnostic tests

 

 

80% of approved amount

 

 

20% of approved amount*

CLINICAL LABORATORY SERVICES

Blood tests; urinalysis

 

Generally100%

of approved amount

 

Nothing for services

HOME HEALTHCARE

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

OUTPATIENT HOSPITAL TREATMENT

Hospital services for the diagnosis or treatment of an illness or injury

 

Medicare payment to hospital, based on outpatient procedure payment rates

 

Coinsurance based on outpatient payment rates

 

BLOOD

 

80% of approved amount after first 3 pints of blood.

First 3 pints plus 20% of approved amount* for additional pints
EXCESS DOCTOR CHARGES

(Above Medicare-approved amount)

 

0% above approved amount

 

All costs

 

*On all Medicare-covered expenses, a doctor or other healthcare 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 can charge for covered services. In 2016, the most a physician can charge for services covered by Medicare is 115% of the approved amount for nonparticipating physicians. Note: In New York, the most a physician can charge for services covered by Medicare is 105%

of the approved amount for nonparticipating physicians. For routine office visits covered by Medicare, a nonparticipating physician can charge up to 115% of the fee schedule amount.