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Out-of-Pocket-Expenses

With original Medicare only, there is no cap or limit on your annual out of pocket exposure and there is a cost associated with just about any type of medical care that you get. That is why it is so important to consult with an experienced Medicare plans broker and advisor. Here is a list of some of the more common out of pocket expenses you might have with original Medicare:

Inpatient Hospital Care:
You pay for days 1-60 an initial deductible of $1,556.00. For days 61-90, you pay $389.00 each day. For days 91-150 you pay $778.00 per day. You pay 100% for each day thereafter.

Skilled Nursing Facility: For days 1-20 you pay nothing. For days 21-100 you pay $194.50 per day. You pay 100% for each day thereafter.

Doctor Office Visits: After you pay your $233.00 annual Medicare Part B deductible, you pay 20% of Medicare approved charges/amounts. If the doctor does not accept Medicare assignment as payment in full, you must pay an additional 15% of the charges.

Chiropractic Services: After you meet your $233.00 annual deductible, you pay 20% of Medicare approved charges/amounts for manual manipulation of the spine to correct subluxation. If the chiropractor does not accept Medicare assignment as payment in full, you must pay an additional 15%.

Outpatient Surgery: After you meet your $233.00 annual Medicare Part B deductible, you pay 20% of Medicare approved amounts for the surgeon and the outpatient facility charges. If the surgeon does not accept Medicare assignment as payment in full, you must pay an additional 15%.

Ambulance: You pay 20% of Medicare approved amounts, and the Medicare Part B deductible of $233.00 applies.
Emergency Care: You pay 20% of the facility charge and 20% of the emergency room physicians’ charges. The Medicare Part B deductible of $233.00 applies.

Diagnostic Tests, X-Rays and Lab Services: You pay 20% of Medicare approved amounts except for approved preventive care services, for which you pay nothing. Otherwise, the Medicare Part B deductible of $233.00 also applies.

It is important to understand how quickly and how high these costs can add up if you have  original Medicare only. For example, if you had an extended hospital stay of 150 days, you would owe $49,266.00. If you were in the hospital for a year, you could owe more than $1.7 million. Please contact us to learn more about your options.

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