If Your Yearly Income is

You pay

File Individual Tax Return

File Joint Tax Return

$82,000 or below

$164,000 or below

$96.40*

$82,001-$102,000

$164,001-$204,000

$122.20*

$102,001-$153,000

$204,001-$306,000

$160.90*

$153,001-$205,000

$306,001-$410,000

$199.70*

Above $205,000

Above $410,000

$238.40*

Blood

You pay all costs for the first 3 pints of blood you get as an inpatient, then 20% of the Medicare-approved amount for additional pints of blood (unless you or someone else donate to replace what’s used).

Home Health Care

You pay:

• $0 for home health care services

• 20% of the Medicare-approved amount for durable medical equipment

Hospice

You pay: a copayment of up to $5 per prescription for outpatient Care prescription drugs and 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest). You may have to pay room and board if you get hospice care in a facility other than for short-term general inpatient care or respite care. 

Hospital Stay

You pay:

• $1,068 deductible and no coinsurance for days 1–60 each benefit period

• $267 per day for days 61–90 each benefit period

• $534 per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime)

Skilled Nursing Facility 

You pay:

• $0 for the first 20 days each benefit period

• $133.50 per day for days 21–100 each benefit period

• All costs for each day after day 100 in the benefit period

Note: All Medicare Advantage Plans must cover these services. Costs vary by plan but may be either higher or lower than those noted above. Check with your plan. 

Blood

You pay all costs for the first three pints of blood you get

as an outpatient, then 20% of the Medicare-approved

amount for additional pints of blood (unless donated to replace what’s used).

Clinical Laboratory Services 

You pay $0 for Medicare-approved services.

Home Health Services

You pay $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.

Medical and Other Services

You pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy*, most preventive services, and durable medical equipment.

Mental Health Services 

You pay 50% for most outpatient mental health care.

Other Covered Services 

You pay copayment or coinsurance amounts.

Outpatient Hospital Services 

You pay a coinsurance or copayment amount that varies by service.

Part B Deductible

You pay the first $135 yearly for Part B-covered services or items.

Part B Deductible *In 2009, there may be limits on physical therapy, occupational therapy, and speech-language pathology services. If so, there may be exceptions to these limits. Note: All Medicare Advantage Plans must cover these services. Costs vary by plan but may be either higher or lower than those noted above.

Part C (Medicare Advantage Plan) Costs for Covered Services and Supplies: Medicare Advantage Plans must cover all Part A and Part B-covered services and supplies. Check your plan’s materials for actual amounts.

Part D (Medicare Prescription Drug Plan) Costs for Covered Prescription Drugs: Call our office for Cost information for the Medicare Prescription Drug Plans in your area or from the plan. Check your plan’s materials for actual amounts.

The figures below are used to determine the Part D late enrollment penalty.    Part D National Base Beneficiary Premium $27.93 -- 1% Penalty Calculation $.28.