Original Medicare & Medigap
Medicare Part A (2021)
|Hospital Inpatient Stay||Deductible: $1,484 per benefit period||First 60 Days Cost: You pay $0. Medicare pays.|
|Days 61-100 Cost: You pay $371 a day. Medicare pays the rest.|
|Days 101-150 Cost: You pay $742 a day. Medicare pays the rest.|
|Days 150+ Cost: You pay 100%|
|Skilled Nursing Facility Care Stay||Only after a 3-day inpatient stay at a hospital. Skilled Nursing Care is a technical term and does not include solely custodial care||First 20 days Cost: You pay $0. Medicare pays.
Days 21-100 Cost: You pay the first $185.50 a day. Medicare pays the rest.
Days 101+: You pay 100%
|Inpatient Psychiatric Care||190 days lifetime benefit, Medicare pays 100%|
Medicare Part B (2021): Part B Deductible = $203.00 Annually
|$88,000 or less||$176,000 or less||$148.50|
|$88,000 – $111,000||$176,000 – $222,000||$207.90|
|$111,000 – $138,000||$222,000 -$276,000||$297.00|
|$138,000 – $165,000||$276,000 – $330,000||$386.10|
|$165,000 – $500,000||$330,000 – $750,000||$475.20|
|Greater than $500,000||Greater than $750,000||$504.90|
Medicare Part D (2021)
|$88,000 or less||$174,000 or less||Plan Premium|
|$88,000 – $111,000||$176,000 – $222,000||$12.30 + Plan Premium|
|$111,000 – $138,000||$222,000 -$276,000||$31.80 + Plan Premium|
|$138,000 – $165,000||$276,000 – $330,000||$51.20 + Plan Premium|
|$165,000 – $500,000||$330,000 – $750,000||$70.70 + Plan Premium|
|Greater than $500,000||Greater than $750,000||$77.10 + Plan Premium|
3,110How to read the chart: If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit.
Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible.
|Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B Coinsurance or Copayment||X||X||X||X||X||X||50%||75%||X||X***|
|Blood (First 3 Pints)||X||X||X||X||X||X||50%||75%||X||X|
|Part A Hospice Care Coinsurance or Copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled Nursing Facility Care Coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A Deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B Deductible||X||X|
|Medicare Part B Excess Charges||X||X|
|Foreign Travel Emergency (Up to Plan Limits)||X||X||X||X||X|
|Out-of Pocket Limit**|
* Plan F and Plan G (beginning in January, 2020) also offers a high-deductible plan. lf you choose this option, this means you must pay for Medicare-covered costs up to the high deductible amount before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
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