Deductible and Coinsurance for Medicare Part A

When you have Medicare Part A, this insurance pays for hospital care, including skilled nursing facilities and other institutional settings. But Medicare Part A doesn’t pay for everything – you must pay a deductible and coinsurance when you have a claim. If you have a Medigap policy or Medicare Advantage (Part C), some or all of the deductible and coinsurance may be covered as part of that policy.

The figures listed below are for 2018 – the deductible and coinsurance amounts change annually.

Part A Deductible

With Medicare Part A, the deductible is complicated. It’s based on each benefit period, not each calendar year, as most deductibles are. For 2018, the Part A deductible is $1,340 per benefit period. It is very possible (and common) to have more than one benefit period deductible payment in a calendar year. This means that, for each time (with some limits) that you are hospitalized or in a skilled nursing facility, you are subject to this deductible.

A benefit period begins with the first day that you enter the hospital or skilled nursing facility, and ends when you have not received inpatient services from a hospital or skilled nursing facility for 60 days in a row.

As you can imagine, it’s very common to have more than one benefit period for the Part A deductible in a year.

Part A Coinsurance

The coinsurance payment varies depending upon where you are in terms of the duration of each benefit period (2018 figures):
• Days 1-60: $0 coinsurance
• Days 61-90: $335 per day
• Days 91 and beyond: $670 per day until lifetime reserve days are used*
• Beyond lifetime reserve days: 100% of all costs

The third level of coinsurance refers to lifetime reserve days. Each Medicare Part A enrollee has 60 lifetime reserve days to use over their lifetime. These are used when a benefit period (hospitalized or in a skilled nursing facility) extends beyond the 90th day. These lifetime reserve days allow for a limited coinsurance for these extended days. Otherwise, after the reserve days are used up, the enrollee is responsible for all costs during that benefit period.

Of course, Medigap policies or Medicare Advantage (Medicare Part C) will provide coverage for part or all of the deductibles and coinsurance when these policies are purchased alongside your Medicare Part A.