by Kristin P. Sinclair January 17, 2020
January 2020: It is a new Year and Medicare Cost Sharing has changed for the 2020 Annual Period.
Since Medicare has unlimited out of pocket exposure it is important that the Medicare beneficiary have coverage above and beyond that to the original Medicare. Supplemental coverage options can help pay for that additional out of pocket exposure and different plan designs off different levels of coverage. You can call Kristin at 803-329-0615 to discuss setting up an appoint to review coverage options than can help you protect your out of pocket exposure.
Medicare Part A in 2020 has a $1,408.00 deductible for Hospital Admission as an inpatient. That amount is applicable whether You are admitted for one day or up to 60 consecutive days. On days 61 through 90 the Medicare beneficiary would have a co-payment responsibility of $352.00 per day. On days 91 through 150 which are one time use life time reserve days the Medicare beneficiary would have a co-payment responsibility of $704.00 per day. At which point Medicare would have paid as much toward that admission as could be paid by the original Medicare.
It is possible for a Medicare beneficiary to have several admissions into the Hospital during an annual period, and have to a need to meet deductibles and co-payments on multiple occasions during the annual period.
After three days as an inpatient in the Hospital and having the need to be admitted to a Skilled Nursing Facility with in a 30 day period after the inpatient hosital stay of the 3 days or moreof inpatient care , for the reason associated with that inpatient hospital care. Hospitalization was a necessary Medicare care occurrence Medicare Part A would pay in full the first 20 days of Skilled Nursing Home services. For days 21 through 100 the Medicare Beneficiary would be responsible for the first $176.00 per day co-payment. Medicare would pay the amount above the $176.00 per day for the days of 21 through 100. After the 100th day of continuous Skilled Nursing Home care Medicare would not pay for any additional days. Medicare does not pay for Long Term Care.
Medicare Part A does not pay for the first three pints of blood, however, after the first three pints of blood Medicare would pay for Medically necessary additional pints while in the Hospital.
Medicare Part A pay for all but limited co-insurance and co-payments for outpatient drugs while in Hospice Care. As well as limited in-patient respite care. Note: the intention of Hospice Care is to provide quality of life care at the end of life, but it is not intended to extend life or help the patient recover from an illness. The Patient must meet Medicare requirement for admission to Hospice for end of life care.
Medicare Part B in 2020 has a deductible of $198.00 which is a one time annual deductible. Followed by 20% co-insurance for the Medicare negotiated rate. Which is the 20% of the Medicare approved rate. And it is possible for the Medicare beneficiary to also be responsible for any excess charges as well. The excess charges would be associated with a Medicare covered item being provided by a Medicare provider who does agree to see Medicare patients however, their charges could be up to 15% higher than Medicare approved rates. If the medical treatment is not a Medicare Part B approved service the Medicare beneficiary would be responsible for the total charges associated with that medical care being received.
Any time you are receiving medical care, the medicare beneficiary should inquire as to whether the medical care is a medicare covered service, so that the beneficiary can make decisions as to whether they want to assume any additional financial responsibility. Concierge services are an example of medical care that is not covered by Medicare.
Medicare Part B does not cover the cost associated with the first 3 pints of blood received on an out-patient basis but would cover the cost of blood over and above the 3 pints, based upon medical necessity and the patient paying for their cost sharing responsibly.
Medicare as a general rule will pay the charges associated with medically necessary Skilled care services received at home and medical supplies associated with the skilled care. This care is being considered medically necessary while recovering. While returning to an improved level of health. Medicare does not offer unlimited Skilled Care in the Home setting. After a period of care if improvement is not being realized the Skilled Level of Home Care would no longer be considered Medically necessary and would end. It is also important the Medicare Beneficiary is aware that, Medicare Part B does not covered other levels of non skilled care, associated with at home care. Medicare Part B has cost sharing associated with Durable Medical Equipment. Such as the Annual deductible of $198.00 if not already met as well as the 20% co-sharing co-insurance amount.
The Medicare Beneficiary should receive the Durable Medical Equipment from a Medicare approved preferred provider to save as much out of pocket exposure for any Durable Medical Equipment. The Medicare approved preferred provider will go over proper use of the durable medical equipment as well. You can research available preferred providers by referring to the Medicare.gov available resources.
Medicare pays nothing for Medical care received outside of the United States or the U.S. protectorates. For more on this topic the Medicare beneficiary should review the information available at Medicare.gov.
Original Medicare has preventative care services that are covered events and a list of those services provided will be covered in a separate article. You can also review these covered items by referring to the Medicare.gov publications available on line.
Updated in Rock Hill SC
by Kristin P Sinclair A Accu Tax (803)329-0615
January 17, 2020