Published April 2, 2020

Medicare and Medicaid Programs: CY 2020 Hospital Outpatient Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy responsible for a co-pay of 20 percent of the charges for a hospital service, he or city of charleston 2020 benefits guide – Charleston-SC.gov. Days 1-60: $1,364 deductible. Days 61-90: $341 coinsurance each day. Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime). Each day after the lifetime reserve days: All costs.You don’t have to pay a deductible for care you get in the inpatient rehabilitation facility if you were already charged a deductible for care you got.

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

Medicare Hospital Copay 2020

The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.

Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.

Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.

COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.

These services can typically come with costs such as copays and deductibles.

With waived coinsurance and deductibles for COVID-19 treatment, savings can add up

Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.

Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).

While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.

Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:

• Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
  There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days.
  
• Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
  After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.

For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.

“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna¹

“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.

Cigna’s cost-sharing waiver expires May 31, 2020.

“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”²

Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.

Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.

Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.

“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”³

Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.

A copay is your share of a medical bill after the insurance provider has contributed its financial portion. Medicare copays (also called copayments) most often come in the form of a flat-fee and typically kick in after a deductible is met.

A deductible is the amount you must pay out of pocket before the benefits of the health insurance policy begin to pay.

Understanding Medicare Copayments & Coinsurance

Medicare copayments and coinsurance can be broken down by each part of Original Medicare (Part A and Part B). All costs and figures listed below are for 2021.

Medicare Part A

After meeting a deductible of $1,484, Medicare Part A beneficiaries can expect to pay coinsurance for each day of an inpatient stay in a hospital, mental health facility or skilled nursing facility. Even though it's called coinsurance, it operates like a copay.

• For hospital and mental health facility stays, the first 60 days require no Medicare coinsurance
• Days 61 to 90 require a coinsurance of $371 per day
• Days 91 and beyond come with a $742 per day coinsurance for a total of 60 “lifetime reserve' days

These lifetime reserve days do not reset after the benefit period ends. Once the 60 lifetime reserve days are exhausted, the patient is then responsible for all costs.

2020 Medicare Deductible

For a stay at a skilled nursing facility, the first 20 days do not require a Medicare copay. From day 21 to day 100, a coinsurance of $185.50 is required for each day. Beyond 100 days, the patient is then responsible for all costs.

Under hospice care, you may be required to make copayments of no more than $5 for drugs and other products related to pain relief and symptom control, as well as a 5% coinsurance payment for respite care.

Under Part A of Medicare, a 20% coinsurance may also apply to durable medical equipment utilized for home health care.

Medicare Part B

Medicare Co Payment 2020

Once the Medicare Part B deductible is met, you may be responsible for 20% of the Medicare-approved amount for most covered services. The Medicare-approved amount is the maximum amount that a doctor or other health care provider can be paid by Medicare.

Some screenings and other preventive services covered by Part B do not require any Medicare copays or coinsurance.

Understanding Medicare Deductibles

Medicare Part A and Medicare Part B each have their own deductibles and their own rules for how they function.

Medicare Part A

The Medicare Part A deductible in 2021 is $1,484 per benefit period. You must meet this deductible before Medicare pays for any Part A services in each benefit period.

Medicare Part A benefit periods are based on how long you've been discharged from the hospital. A benefit period begins the day you are admitted to a hospital or skilled nursing facility for an inpatient stay, and it ends once you have been out of the facility for 60 consecutive days. If you were to be readmitted after 60 days of being home, a new benefit period would start, and you would be responsible for meeting the entire deductible again.

Medicare Part B

The Medicare Part B deductible in 2021 is $203 per year. You must meet this deductible before Medicare pays for any Part B services.

Unlike the Part A deductible, Part B only requires you to pay one deductible per year, no matter how often you see the doctor. After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most doctor services. This 20 percent is known as your Medicare Part B coinsurance (mentioned in the section above).

Cover your Medicare out-of-pocket costs

There is one way that many Medicare enrollees get help covering their Medicare out-of-pocket costs.

Medigap insurance plans are a form of private health insurance that help supplement your Original Medicare coverage. You pay a premium to a private insurance company for enrollment in a Medigap plan, and the Medigap insurance helps pay for certain Medicare out-of-pocket costs including certain deductibles, copayments and coinsurance.

The chart below shows which Medigap plans cover certain Medicare costs including the ones previously discussed.

Scroll to the right to continue reading the chart

Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

¹ Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

² Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

³ Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

⁴ Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

If you're ready to get help paying for Medicare out-of-pocket costs, you can apply for a Medigap policy today.

Find Medigap plans in your area.

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