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  • Prepare for Enrollment

  • Review Cost and Coverage

  • Understand Coverage Gaps

  • Explore Medicare Advantage

  • Evaluate Your Options

  • Make an Educated Decision

Review Cost and Coverage

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When choosing a Medicare plan, two most essential questions are "What’s covered?" and "How much will it cost?" 

 

Let’s start with what’s covered—Medicare comes in four parts, each serving a different role in helping cover your healthcare needs.¹

Government Sponsored Medicare Program

Also known as Original Medicare, Parts A and B come standard for most Americans who turn 65 years old or qualify due to an eligible disability —they cover the more basic healthcare services.

Private Insurance Plans

Parts C and D can be purchased separately—they’re designed to fill coverage gaps that Original Medicare doesn’t account for, which we’ll discuss in more depth later in the guide.


Breaking down Original Medicare Parts A and B

Learn the ins and outs of Original Medicare—what it covers, what it doesn’t, and how much you may expect to pay.

What is Part A?

What is Part A?

Part A helps cover a variety of costs including inpatient stays, inpatient mental health, skilled nursing, and hospice care.²

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What’s covered

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Costs without insurance

What’s covered

Overnight hospital stays, including a semi-private room, meals, general nursing, and medications taken as part of your treatment, and some additional services and supplies.⁶

Costs without insurance

Depending on your length of stay, you’ll first pay an inpatient hospital deductible—in 2024, this totaled $1,600.

After paying that, Medicare will cover 100% of the cost of your stay for the first 60 days. For days 61-90, in 2024 you would've paid $400 per day.

And after day 90, you enter into your bank of “lifetime reserve days,” which is up to 60 reserve days of inpatient hospital coverage that can be used over your lifetime. You’ll pay $800 per day during your lifetime reserve days. Once you’ve used these up, you’ll be responsible for all costs.⁷

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What’s covered

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Costs without insurance

What’s covered

Skilled nursing facilities provide a high level of medical care such as wound care, IVs, injections, physical therapy, and monitoring of vital signs—this level of care requires trained medical professionals such as a registered nurse or therapist. These facilities may be used for rehabilitation after an injury, stroke, or other condition. They may also be used to treat patients who require constant monitoring and care, but don’t need to be in a hospital.

Costs without insurance

Original Medicare will cover 100% of the cost for the first 20 days of a qualified stay. If you are admitted for longer, you will pay $200 per day for days 21 through 100. After 100 days, you will be responsible for all costs.8

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What’s covered

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Costs without insurance

What’s covered

Part A covers admittance to inpatient mental health facility or psychiatric hospital for a maximum of 190 days over your lifetime.

Costs without insurance

The costs for an inpatient mental health stay are the same as inpatient hospital stay costs. For the doctor’s services, you will generally pay 20% of the Medicare-approved amount.7

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Coverage

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Costs without insurance

Coverage

Hospice care focuses on increasing quality of life through pain relief and symptom control, in addition to treatment for mental and emotional health needs. Sometimes referred to as “end of life care,” hospice is typically administered when the diagnosis is deemed terminal or when a cure is not expected. It’s usually received in a patient’s home or other facility where the patient lives, like a nursing home or an assisted nursing facility.

Costs without insurance

Costs without insurance: Original Medicare will generally cover 100% of Hospice care costs. A copayment of up to $5 may be charged for each outpatient prescription drug prescribed for pain relief and symptom control. For short-term inpatient respite care, you may be responsible for 5% of the Medicare-approved charges at a Medicare-approved facility.9

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What is Part B?
What’s 100% covered
What’s not fully covered?

What is Part A?

Part A helps cover a variety of costs including inpatient stays, inpatient mental health, skilled nursing, and hospice care.²

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What’s covered

alt-text-image

Costs without insurance

What’s covered

Overnight hospital stays, including a semi-private room, meals, general nursing, and medications taken as part of your treatment, and some additional services and supplies.⁶

Costs without insurance

Depending on your length of stay, you’ll first pay an inpatient hospital deductible—in 2024, this totaled $1,600.

After paying that, Medicare will cover 100% of the cost of your stay for the first 60 days. For days 61-90, in 2024 you would've paid $400 per day.

And after day 90, you enter into your bank of “lifetime reserve days,” which is up to 60 reserve days of inpatient hospital coverage that can be used over your lifetime. You’ll pay $800 per day during your lifetime reserve days. Once you’ve used these up, you’ll be responsible for all costs.⁷

Show MoreShow Less

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What’s covered

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Costs without insurance

What’s covered

Skilled nursing facilities provide a high level of medical care such as wound care, IVs, injections, physical therapy, and monitoring of vital signs—this level of care requires trained medical professionals such as a registered nurse or therapist. These facilities may be used for rehabilitation after an injury, stroke, or other condition. They may also be used to treat patients who require constant monitoring and care, but don’t need to be in a hospital.

Costs without insurance

Original Medicare will cover 100% of the cost for the first 20 days of a qualified stay. If you are admitted for longer, you will pay $200 per day for days 21 through 100. After 100 days, you will be responsible for all costs.8

Show MoreShow Less

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What’s covered

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Costs without insurance

What’s covered

Part A covers admittance to inpatient mental health facility or psychiatric hospital for a maximum of 190 days over your lifetime.

Costs without insurance

The costs for an inpatient mental health stay are the same as inpatient hospital stay costs. For the doctor’s services, you will generally pay 20% of the Medicare-approved amount.7

Show MoreShow Less

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Coverage

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Costs without insurance

Coverage

Hospice care focuses on increasing quality of life through pain relief and symptom control, in addition to treatment for mental and emotional health needs. Sometimes referred to as “end of life care,” hospice is typically administered when the diagnosis is deemed terminal or when a cure is not expected. It’s usually received in a patient’s home or other facility where the patient lives, like a nursing home or an assisted nursing facility.

Costs without insurance

Costs without insurance: Original Medicare will generally cover 100% of Hospice care costs. A copayment of up to $5 may be charged for each outpatient prescription drug prescribed for pain relief and symptom control. For short-term inpatient respite care, you may be responsible for 5% of the Medicare-approved charges at a Medicare-approved facility.9

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5 ways you may get help paying

Read up on the programs that may help  paying for Medicare costs a little bit easier for those who qualify.

Dual-eligible

Dual-eligible

Dual-eligible is the term used to describe people who qualify for both Medicare and Medicaid. Dual-eligible beneficiaries are individuals who are enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits. They may receive cost sharing through state-run Medicare Savings Programs (MSP), which provide help for premiums, deductibles, coinsurance and copayments, depending on the participant's income level and the specific MSP.5

Some private insurance companies, like Humana, have Medicare Advantage plans that are specifically designed for Dual-eligible consumers. Medicare Advantage Dual-Eligible Special Needs Plans often combine all the benefits of Medicaid and Medicare, and may also include coverage for routine dental, vision and hearing care; nonemergency transportation to and from medical care; fitness programs; an over-the-counter medication allowance and more.

Think you may be dual-eligible? Find out and learn about the benefits of these plans

Plans not available in all areas.  Costs, coverage, and benefits vary by location. 

“Extra Help” with Prescription Drug Costs Low Income Subsidy (LIS)

Medicare Savings Programs (MSP)

Programs of All-inclusive Care for the Elderly (PACE)

Supplemental Security Income (SSI) benefits

Dual-eligible

Dual-eligible is the term used to describe people who qualify for both Medicare and Medicaid. Dual-eligible beneficiaries are individuals who are enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits. They may receive cost sharing through state-run Medicare Savings Programs (MSP), which provide help for premiums, deductibles, coinsurance and copayments, depending on the participant's income level and the specific MSP.5

Some private insurance companies, like Humana, have Medicare Advantage plans that are specifically designed for Dual-eligible consumers. Medicare Advantage Dual-Eligible Special Needs Plans often combine all the benefits of Medicaid and Medicare, and may also include coverage for routine dental, vision and hearing care; nonemergency transportation to and from medical care; fitness programs; an over-the-counter medication allowance and more.

Think you may be dual-eligible? Find out and learn about the benefits of these plans

Plans not available in all areas.  Costs, coverage, and benefits vary by location. 


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Test your knowledge

See how well you know Original Medicare costs and coverages by matching the terms to their correct definitions.

 


Frequently Asked Questions about Cost and Coverage

Offered by the federal government, it includes Part A (hospital insurance) and Part B (medical insurance) benefits. Original Medicare helps cover hospital and doctor visits.

In most cases, you usually don't pay a monthly premium for Medicare Part A (hospital) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working.

You do need to pay a premium for Part B coverage. In 2024, the Medicare Part B premium is $164.90 or higher depending on your income.

Yes. Most people will pay a deductible for parts A and B. The 2024 Part A deductible for inpatient hospital coverage is $1,600. The 2024 annual deductible for Part B medical coverage is $226.00.

Original Medicare does not include Part D prescription drug coverage, but it does include drugs given during medicare-covered stays in the hospital or in a skilled nursing facility. You may choose to purchase a stand-alone prescription drug plan or a Medicare Advantage Prescription Drug Plan from a private company.

Yes. If you are enrolled in Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare. If you have Medicare coverage through a private insurance company, you may save money by staying in your plan’s network.

You can enroll or change plans two times a year. First during the annual enrollment period from Oct 15 – Dec 7 and then again during Open Enrollment from Jan 1 – March 31. From April 1 – Oct 15 you will need to qualify for a special enrollment period to switch plans. If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare.

Yes. Preexisting conditions, also known as previous health conditions, do not affect your Medicare eligibility and coverage. Original Medicare (Part A and Part B) is available to any individual age 65 or older, younger than 65 with a disability, or any age with end-stage kidney disease (ESKD).1

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  • Prepare for Enrollment

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  • Evaluate Your Options

  • Make an Educated Decision

Plans not available in all areas. Costs, coverage, and benefits vary by location.

This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional.

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Humana is also a Coordinated Care plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in any Humana plan depends on contract renewal.

 

Humana Inc. and its subsidiaries (collectively, “Humana”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or expression, transgender status, marital status, military or veteran status, or religion. Humana does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, sexual orientation, gender identity or expression, transgender status, marital status, military or veteran status, or religion. We also provide free language interpreter services. See our full accessibility rights information and language options.

 

Florida residents: FL Dual-Eligible Special Needs Plans are sponsored by Humana Medical Plan, Inc. and the State of Florida, Agency For Health Care Administration.

 

Tennessee residents: NOTICE: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any reference to more, extra, or additional Medicare benefits, is applicable to Medicare only and does not indicate increased Medicaid benefits.

 

Ohio residents: For the Humana Cleveland Clinic Preferred HMO and D-SNP plans, other ancillary providers such as labs and durable medical equipment suppliers, and pharmacies are available in our network.

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Last updated: 4/12/2025