Medicare-covered services in the main does not paid 100%, although there are a number of exceptions. The following schedule of categories of benefits illustrates the gaps.
Year 2008 Medicare Benefits - Part A
Hoapital charges - Patient pays the first $1,024 of any charges for the first 60 days.*
Next 30 days 61-90 days (continuous confinement)* Patient pays $256 per day.
Days 91-150 charged against lifetime aggregaterr rereserve of 60 days. $512 per day. After Day 90, if lifetime reserve days have been used: Patient pays 100%.
Skilled Nursing Facility
First 20 days in full: Patient pays 100%.
Next 80 days (continuous confinement) Patient pays $128.00 each day
After Day 100, Patient pays 100%.
Part B - Medical
Medicare pays 80% of approved charges after a deductible of First $135 per calendar year
Patient’s pays first $135 then **20% of approved amount.
*Each “benefit period” begins with the first day at the hospital or skilled nursing facility, and ends after the patient has been out of that facility for 60 consecutive days (including date of discharge).
**The exceptions are hospital outpatient services which may vary according to the service.
The above clearly indicates the potential financial liability for the Medicare Beneficiary who does not have Medigap, HMO, Medicaid or an Employer Health Retirement Plan.
Standard Medicare Part D Prescription Drug Coverage: 2008 Coverage Cost
First $275 (rx) Deductible Beneficiary pays $275
$275-2510 (rx) 25% Co-Pay Beneficiary pays up to $558.75
$2511-57263.25 (rx) Deductible Beneficiary pays up to $3216.25
The coverage gap ends when your total out-of-pocket costs for covered drugs reach $4050. After you reach this catastrophic coverage limit, you will pay either $2.25 for generic drugs and $5.60 for brand-name drugs, or 5% of the prescription cost, whichever is greater.
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