Ditto impressed but need to see where that is coming from.
adding @WendyBG It has gone up this year to $1676. What @intercst is forgetting are all the other copays.
To calculate a Medigap payout for a hospital stay, you first need to understand the costs associated with the hospital stay under Original Medicare (Part A), then determine how your Medigap plan covers those costs, including deductibles, coinsurance, and copays.
Here’s a breakdown:
- Original Medicare (Part A) Costs:
- Deductible:
You’ll pay a deductible per benefit period (a period of consecutive days of hospitalization). In 2025, the Part A deductible is $1,676.
- Coinsurance:
After meeting the deductible, you’ll pay coinsurance for days 61-90 ($419 per day) and days 91-150 (lifetime reserve days) ($838 per day).
- Lifetime Reserve Days:
Medicare covers up to 60 lifetime reserve days (days 91-150) with a daily coinsurance.
- After 150 Days:
You pay 100% of the costs.
- Medigap Plan Coverage:
- Deductible Coverage:
Medigap plans vary in their coverage of the Part A deductible. Some plans fully cover it, while others cover a percentage.
- Coinsurance Coverage:
Medigap plans typically cover the coinsurance amounts for days 61-90 and 91-150, helping to reduce your out-of-pocket costs.
- Out-of-Pocket Maximum:
Some Medigap plans have an out-of-pocket maximum, meaning that once you reach that limit, the plan pays 100% of covered costs for the rest of the year.
- Additional Benefits:
Some Medigap plans offer additional benefits, such as coverage for skilled nursing facility costs, home health aide services, and prescription drug costs.
- Calculating Your Medigap Payout:
- Identify Your Medigap Plan:
Determine which Medigap plan you have and its specific benefits.
- Calculate Original Medicare Costs:
Determine the total cost of your hospital stay under Original Medicare, including the deductible, coinsurance, and any other applicable costs.
- Determine Medigap Coverage:
See how your Medigap plan covers those costs, including any deductible coverage, coinsurance coverage, and out-of-pocket maximums.
- Calculate Your Medigap Payout:
Subtract the amount your Medigap plan covers from the total cost of your hospital stay under Original Medicare to determine your out-of-pocket expenses.
Example:
Let’s say you have a hospital stay that costs $10,000 under Original Medicare, and your Medigap plan covers the full deductible ($1,676) and 100% of the coinsurance.
- Original Medicare Costs: $10,000
- Medigap Coverage: $1,676 (deductible) + coinsurance amount
- Your Out-of-Pocket Costs: $10,000 (Original Medicare costs) - Medigap coverage = Your out-of-pocket costs.
Important Notes:
- Benefit Periods:
A benefit period begins when you’re admitted to a hospital and ends when you’ve been out of the hospital for 60 consecutive days.
- Lifetime Reserve Days:
You have a total of 60 lifetime reserve days that can be used during your lifetime.
- Medigap Plan Variations:
Medigap plans vary in their coverage, so it’s essential to understand the specific benefits of your plan.
- Contact Your Medigap Provider:
For specific questions about your Medigap plan’s coverage, contact your Medigap insurance provider.
- Inpatient Hospital Care Coverage - Medicare
In 2025 you pay: * Days 1–60: (of each benefit period): $0 after you meet your Part A deductible ($1,676). * Days 61–90: (of each…
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Medicare
- Costs - Medicare
Days 1-60: $0 after you pay your Part A deductible. Days 61-90: $419 each day. … After day 150: You pay all costs. … Days 1-20…
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Medicare
- Medigap - Center for Medicare Advocacy
Hospital deductible per spell of illness; Hospital coinsurance payments (Medicare covers the first 60 days in full after the deduc…
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