Variation and Trends in Medigap Premiums. Appendix A: Medicare Benefits for Parts A and B and Cost Sharing Requirements, 2011



$1,132 per benefit period

Inpatient hospital
   Days 1-60
   Days 61-90
   Days 91-150
   After 150 Days

No coinsurance
$283per day
$566 per day (for up to 60 lifetime reserve days)
Not covered

Skilled nursing facility
   Days 1-20
   Days 21-100
   After 100 Days
No coinsurance
$141.50 per day
Not covered
Home Health No coinsurance; no limit on number of visits
Hospice No coinsurance for hospice care; copayment of up to $5 for outpatient drugs and 5% coinsurance for inpatient respite care
Inpatient psychiatric hospital Up to 190 days in a lifetime


* Medicare Part B premiums vary with income and are higher for those with incomes above $85,000 (filing individually) /$170,000(filing jointly).  For more information, see
* This table does not include all Medicare-covered benefits or preventive services; for a complete listing, see and
SOURCE:  CMS, “Your Medicare Benefits, 2011”
Deductible $162
Premium Most beneficiaries pay $96.40/month or $110.50/month (for new beneficiaries in 2010)*
Physician and other medical services
   MD accepts assignment
   MD does not accept assignment
20 % coinsurance
20% coinsurance, plus up to 15% above the Medicare-approved fee
Outpatient hospital care 20% coinsurance
Ambulatory surgical services 20% coinsurance
Diagnostic tests, X-rays, and lab services 20% coinsurance
Durable medical equipment 20% coinsurance
Physical, occupational, and speech therapy 20% coinsurance; certain limits may apply
Clinical laboratory services No coinsurance
Home health care No coinsurance; no limit on number of visits
Outpatient mental health services 45% coinsurance (gradually decreasing to 20% in 2014)
Preventive Visits
   One-time “Welcome to Medicare” visit
   Annual “Wellness” visits
$0 copay, Part B deductible does not apply
$0 copay, Part B deductible does not apply
Preventive services**
   Abdominal aortic aneurysm screening
   Bone mass measurement
   Breast cancer screening/mammograms
   Cardiovascular screening tests
   Certain types of colorectal cancer screenings
   Diabetes screening tests
   Flu shots & Hepatitis B shots
   HIV screening tests
   Medical nutrition therapy services for certain individuals
   Pap tests and pelvic exams
   Pneumococcal shot
   Prostate cancer screening
   Smoking cessation counseling
Beginning in 2011, preventive services ranked “A” or “B” by the US Preventive Services Task Force are generally covered with no cost sharing (if the doctor accepts assignment), and the Part B deductible does not apply.  Beneficiaries may have to pay 20% of the Medicare-approved amount for the doctor's visit for certain preventive services.


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