Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
This MLN Matters is found here with the corresponding Transmittal: R11641GI. The rates are provided in both documents.
An excerpt from Background: Patients using covered Part A and Part B services may be subject to deductible and coinsurance requirements. Medicare subtracts an inpatient hospital deductible amount from the amount payable to the hospital for inpatient hospital services it provides in a spell of illness.
When a patient gets such services for more than 60 days during a spell of illness, they’re responsible for a coinsurance amount equal to one-fourth of the inpatient hospital deductible for each day of days 61-90 spent in the hospital. A patient has 60 lifetime reserve days of coverage, which they may use after day 90 in a spell of illness. The coinsurance amount for these days is equal to one-half of the inpatient hospital deductible.
A patient is responsible for a coinsurance amount equal to one-eighth of the inpatient hospital deductible per day for days 21-100 of skilled nursing facility (SNF) services provided during a spell of illness. Most individuals age 65 and older, and many disabled individuals under age 65, have Part A benefits without a premium payment. The Social Security Act states that certain aged and disabled persons who aren’t insured may voluntarily enroll but must pay a monthly premium.