Medicare 2016 Basics

As part of our Tuesday Insurance Trends series, we'll devote the next couple of weeks to Medicare Reimbursement Rates. Today we discuss what Medicare is, who is covered by Medicare, and the general rates for 2016. 

What is Medicare?

Medicare is a federal health insurance program that provides insurance for U.S. citizens 65 years and older, as well as citizens who are under 65 with certain disabilities. It also covers anyone with end stage renal disease who is in need of dialysis or a kidney transplant.

How Medicare is covered:

1)      Original Medicare

2)      Private Medicare Advantage Plan

Original Medicare:

Medicare Part A is hospital insurance that covers care in an inpatient hospital, nursing facility, hospice care, or home health care.

Medicare Part B covers outpatient medical care such as doctor visits, lab tests, or preventative care.

Private Medicare Advantage Plan:

Medicare Part C provides the same original Medicare benefits but through private insurance companies through Preferred Provider Organization (PPO) plans or Health Maintenance Organization (HMO) plans.

Medicare Part D covers prescription drug benefits

What do my patients pay for medicare? 

Medicare Advantage payments are expected to have a 1.25% increase this year:

  • Part A Premium- most don't pay a premium 
  • Part A hospital inpatient deductible and coinsurance-
    • $1,288 deductible for each benefit period
    • Days 1-60= $0 coinsurance, Days 61-90= $322 coinsurance/ day of each benefit period, Days 91 += $644 coinsurance/ each lifetime reserve day
  • Part B premium- most pay $104.90 but some will pay $121.80 and up depending on income
  • Part B Deductible and Coinsurance- $166/ year plus 20% of most doctor services
  • Part C and Part D premiums both vary depending on income

For more information check out: Medicare Costs At A Glance


Next week, we'll dive more into the nutrition side of Medicare by discussing the nutrition services that are covered by Medicare for dietitians and the rates we are reimbursed.