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The Difference in Deductibles: A Medicare Customer Q&A

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What You Need to Know

  • You know what a deductible is.
  • Your client might not.
  • Your client may not understand that one Medicare enrollee could face two more Medicare deductibles.

A deductible is, of course, the amount your clients pays for health care services and prescriptions before Medicare pays, or your prescription drug plan or other insurance provider begins to pay.

Your clients need to understand that this term refers to the out-of-pocket amount that they, as medical patients, are responsible for before insurance coverage kicks in.

To you, this might seem like an elementary topic, but some of your clients may need a refresher.

The Question:

What are the different types of Medicare deductibles, and how do they work?

The Answer:

Medicare has different parts that come with different kinds of deductibles.

O Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. About 99% of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,556 in 2022, an increase of $72 from $1,484 in 2021.

The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2022, beneficiaries must pay a coinsurance amount of $389 per day for the 61st through 90th day of a hospitalization ($371 in 2021) in a benefit period and $778 per day for lifetime reserve days ($742 in 2021).

For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022 ($185.50 in 2021).

O Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other medical and health services not covered by Medicare Part A.

The Medicare Part B premium, deductible, and coinsurance rates are determined each year according to the Social Security Act.

The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, increasing $21.60 from $148.50 in 2021.

The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, increasing $30 from the annual deductible of $203 in 2021.

O Medicare supplement plans, also known as Medigap plans, can help pay some of your Medicare-eligible clients’ out-of-pocket costs, including their Medicare Part A deductibles. These plans are sold through private insurers. There are eight standardized plans across 47 states and the District of Columbia.

There are different standardized plans for Minnesota, Massachusetts, and Wisconsin.

Each plan has a letter for a name.

Some of these plans may cover all or a portion of a client’s Medicare Part A deductible.

Bethany CissellBethany Cissell is a health care insurance services specialist at Allsup.




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