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Getting Benefits

Part A

In 2012, a Medicare enrollee who goes to the hospital pays a deductible of $1,156 for the first day in the hospital. The next 59 days are fully covered by Medicare. For days 61 through 90, the patient is responsible for paying $275 a day (called a co-payment), and Medicare covers the rest. For any additional days, the patient can use up to 60 lifetime reserve days, with a co-payment of $550 a day.

A Medicare enrollee in a skilled nursing facility must pay $144.50 for days 21 through 100. For enrollees who have been hospitalized for three days or more, Medicare covers the first 20 days, but does not cover anything past day 100. Medicare also covers home health, with no limit on the number of visits.

Part B

Medicare enrollees are responsible for paying the first $140 a year in doctor bills—this payment is called the annual deductible. Medicare pays 80% of the approved fee, and the individual pays the remaining 20%, which is called a co-insurance. Doctors may charge more than the Medicare fee schedule under a process called balanced billing. But the patient is not responsible for paying more than 15% above the Medicare fee schedule.

The vast majority—about 76%—of people enrolled in Medicare participate in fee-for-service, or traditional, Medicare. They can choose any doctor or hospital that agrees to take Medicare patients.

About 11.9 million Medicare beneficiaries are enrolled in private health plans, or Medicare Advantage. These plans include managed care plans, preferred provider organizations, private fee-for-service plans, and Medicare specialty plans. If a person decides to join a Medicare Advantage plan, he or she must pay the monthly Medicare Part B premium. The enrollee may also have to pay an additional premium to the Medicare Advantage plan. In return, the beneficiary may receive benefits not covered by fee-for-service Medicare, such as extra days in the hospital and lower cost-sharing. The beneficiary may also be restricted to the plan's network of doctors and hospitals.

The official Medicare website is www.medicare.gov.