Original Medicare Plan Deductible and Co-Insurance Amounts for 2010

Part A (Hospital Insurance- HI)

Medicare Part A pays for services in units known as "Benefit Periods". A Benefit Period begins the day the beneficiary/patient is admitted to the hospital and ends after they have been out of the hospital for 60 consecutive days. For the cost of a hospital stay up to 150 days, please refer to the chart below:

What is it called?	When do I pay?	How much do I pay?
Deductible	Day 1-60	The Medicare Part A deductible of $1,100.00 is due for the first 60 days of an inpatient hospital confinement
Coinsurance	Day 61-90	$275.00 per day
Lifetime Reserve	Day 91-150	$550.00 per day
Skilled Nursing Facility	Day 21-100	$137.50 per day
Home Health Agency	-	No deductible or co-insurance (except for 20% coinsurance for DME, prosthetics, orthotics)
Blood	-	First 3 pints (or equivalent units packed red blood cells) you get as an inpatient, then 20% of the Medicare-approved amount for additional pints of blood. Unless you or someone else donates to replace what is used.
Hospice*	-	You pay a co-payment of up to $5.00 per prescription for outpatient prescription drugs and 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest).  You may have to pay room and board if you get hospice care in a facility other than for short-term general inpatient care or respite care.

Part B (Supplementary Medical Insurance- SMI)

The beneficiary/patient contributes toward their Medicare Part B benefits in three ways: premiums, deductibles and coinsurance. Please see the chart below for a detailed description.

What is it called?	How much do I pay?	When do I pay?
Deductible	$155.00	For the first $155.00 of covered Medicare services.
Clinical Laboratory Services	$0.00	For Medicare approved services.
Home Health Services	$0.00	For Medicare approved services.  You pay 20% of the Medicare approved amount for durable medical equipment.
Medical and Other Services		You pay 20% of the Medicare approved amount for most doctor services, outpatient therapy*, most preventive services, and durable medical equipment.
Mental Health Services		You pay 50% for most outpatient mental health care.
Other Covered Services		You pay co-payment or coinsurance amounts.
Co-insurance	20% of the Medicare allowance	For each covered Medicare service that is provided with the exception of clinical laboratory (reimbursed at 100%)

CMS updates the Part B premium each year. These adjustments are made according to formulas set by statute. By law, the monthly Part B premium must be sufficient to cover 25 percent of the program's costs, including the costs of maintaining a reserve against unexpected spending increases. The federal government pays the remaining 75 percent.

Beginning January 1, 2007, the Part B premium will be based on the income of the beneficiary. Below are the CY 2009 Part B premium amounts based on beneficiary income parameters.

Individual Income = Beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year).

Joint Income (Married) = Beneficiaries who are married and lived with their spouse at any time during the taxable year, and also file a joint tax return.

Married but File Separate = Beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate tax return from their spouse.

• Previous Deductible and Coinsurance Amounts

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