Does Original Medicare have maximum out-of-pocket limits?

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No. There is no current out-of-pocket limit for hospital or medical services covered by Original Medicare. Here is a look at the costs under Original Medicare (Part A and Part B).

Part A Costs

Many people receive Part A without having to pay monthly premiums. This premium-free Part A is for those who are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board at least four months before they turn 65 or those who worked or whose spouse worked as a Medicare-covered government employee or worked for 40 quarters while paying taxes to Social Security. Premium-free Part A is also available to people who are automatically enrolled in Medicare because they qualify due to a disability.

If you have to pay for Medicare Part A, your premiums will depend on how many quarters you or your spouse worked while paying taxes to Social Security or how many work credits you have. People who have 30 to 39 quarters of work while paying taxes will owe $259 each month in 2021. Those with fewer than 30 quarters of work credits will pay $471 each month for Part A.

Coinsurance for Part A comes down to how long your inpatient stay is in either a hospital or skilled nursing facility. For the first 60 days as a hospital inpatient, you will pay nothing in coinsurance. Days 61 to 90, you will owe a daily coinsurance of $371, and day 91 to the last of your lifetime reserve days (you have up to 60) will cost you a daily coinsurance of $742 in 2021. When you have spent your 60 reserve days, you will owe all hospital costs.

Coinsurance for stays in a skilled nursing facility have a different time scale. You pay nothing in coinsurance for the first 20 days. Day 21 to 100 you will owe $185.50 each day in coinsurance. Beyond day 100, you will owe all costs.

The Part A deductible is charge per each benefit period. A benefit period begins when you are admitted as an inpatient and ends when you have not received inpatient care for 60 days. The deductible for 2021 is $1,484 per benefit period.

Part B Costs

Part B covers medically necessary and preventive treatments and services. You will often owe a copayment for hospital outpatient services unless they are your yearly wellness doctor visits or if they are for preventive services. The yearly deductible for Part B is $203 in 2021. After you have paid the deductible in out-of-pocket costs, you will owe coinsurance of 20 percent of the Medicare-approved amount for covered services and items.

Premiums for Part B are determined by your income as filed on your tax returns. The standard premium in 2021 is $148.50 each month for those making less than $88,000 as an individual or less than $176,000 as a married couple filing jointly. Rates increase as income increases.

For more information regarding coverage and costs with Original Medicare, reach out to an agent with Bobby Brock Insurance.

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Justin Brock

President & CEO of Bobby Brock Insurance