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Last Modified: 11/25/2024 Location: FL, PR, USVI Business: Part A, Part B

Medicare deductible, coinsurance, and premium rates: 2022-2025

2025

Effective date: January 1, 2025
Implementation date: January 6, 2025
CMS issued the 2025 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service (FFS) program. The 2025 deductible, coinsurance and base premium rates are:
Part A – Hospital Insurance
Deductible: $1,676
Coinsurance
$419 a day for 61st–90th day
$838 a day for 91st–150th day (lifetime reserve days)
$209.50 a day for 21st–100th day (SNF coinsurance)
Part A Base Premium (BP): $518 a month
Part A BP with 10% surcharge: $569.80 a month
Part A BP with 45% reduction: $285 a month (for those who have 30–39 quarters of coverage)
Part A BP with 45% reduction & 10% surcharge: $313.50 a month
Part B – Supplementary Medical Insurance
Standard Premium: $185 a month
Part B Deductible: $257 a year
Pro Rata Data Amount
• $170.32 first month
• $86.68 second month
Part B Coinsurance: 20%

2024

Effective date: January 1, 2024
Implementation date: January 2, 2024
CMS issued the 2024 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service (FFS) program. The 2024 deductible, coinsurance and base premium rates are:
Part A - Hospital insurance
Deductible: $1,632.00
Coinsurance
$408.00 a day for days 61 through 90
$816.00 a day for days 91 through 150 (lifetime reserve days)
$204.00 a day for days 21 through 100 (skilled nursing facility coinsurance)
Part B - Supplementary medical insurance (SMI)
Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute.
Standard premium: $174.70 a month
Deductible: $240.00 a year
Coinsurance: 20%
Source: MM13365

2023

Effective date: January 1, 2023
Implementation date: January 3, 2023
CMS issued the 2023 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service (FFS) program. The 2023 deductible, coinsurance and base premium rates are:
Part A - Hospital insurance
Deductible: $1,600.00
Coinsurance
$400.00 a day for days 61 through 90
$800.00 a day for days 91 through 150 (lifetime reserve days)
$200.00 a day for days 21 through 100 (skilled nursing facility coinsurance)
Part B - Supplementary medical insurance (SMI)
Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute.
Standard premium: $164.90 a month
Deductible: $226.00 a year
Coinsurance: 20%
Details are available in MLN Matters article MM12903 external pdf file.
KX modifier thresholds
Section 50202 of the Bipartisan Budget Act of 2018 external pdf file repeals the application of the therapy caps while also retaining and adding limitations to ensure appropriate therapy. A provision of section 50202 of the BBA of 2018 adds section 1833(g)(7)(A) of the Act to preserve the former therapy cap amounts as thresholds above which claims must include the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record.
These amounts are now known as the KX modifier thresholds:
PT and SLP services combined: $2,230
OT services: $2,230
Additional details available on CMS’ therapy services page external link.

2022

Effective date: January 1, 2022
Implementation date: January 3, 2022
CMS issued the 2022 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service (FFS) program. The 2022 deductible, coinsurance and base premium rates are:
Part A - Hospital insurance
Deductible: $1,556.00
Coinsurance
$389.00 a day for days 61 through 90
$778.00 a day for days 91 through 150 (lifetime reserve days)
$194.50 a day for days 21 through 100 (skilled nursing facility coinsurance)
Part B - Supplementary medical insurance (SMI)
Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute.
Standard premium: $170.10 a month
Deductible: $233.00 a year
Coinsurance: 20%
Details are available in MLN Matters article MM12507 external pdf file.
Source: CR13796
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