POMS Reference

This change was made on Jan 2, 2018. See latest version.
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HI 00601.560: Inpatient Hospital Coinsurance

changes
*
  • Effective Dates: 11/21/2016 - Present
  • Effective Dates: 01/02/2018 - Present
  • TN 2 (10-04)
  • HI 00601.560 Inpatient Hospital Coinsurance
  • A. Coinsurance
  • The beneficiary is responsible for a daily coinsurance amount of one-fourth of the inpatient hospital deductible for the 61st through the 90th days of inpatient hospital services used during each benefit period.
  • Where the actual charge to the patient for the 61st through the 90th day of inpatient hospital services is less than the applicable coinsurance amount, the coinsurance is the actual charge. (Where the actual charge to the patient for lifetime reserve days is less than the coinsurance amount for those days, the beneficiary is deemed to have elected not to use the days because he/she would not benefit from their utilization.) (See HI 00601.065B.)
  • The following chart shows the inpatient hospital coinsurance amounts for benefit periods beginning in each year since 1974:
  • Year in Which Benefit Period Began
  • Coinsurance Amount
  • 2018
  • $355.00
  • 2017
  • $329.00
  • 2016
  • $322
  • 2015
  • $315
  • 2014
  • $304
  • 2013
  • $296
  • 2012
  • $289
  • 2011
  • $283
  • 2010
  • $275
  • 2009
  • $267
  • 2008
  • $256
  • 2007
  • $248
  • 2006
  • $238
  • 2005
  • $228
  • 2004
  • $219
  • 2003
  • $210
  • 2002
  • $203
  • 2001
  • $198
  • 2000
  • $194
  • 1999
  • $192
  • 1998
  • $191
  • 1997
  • $190
  • 1996
  • $184
  • 1995
  • $179
  • 1994
  • $174
  • 1993
  • $169
  • 1992
  • $163
  • 1991
  • $157
  • 1990
  • $148
  • 1989
  • $0 *
  • 1988
  • $135
  • 1987
  • $130
  • 1986
  • $123
  • 1985
  • $100
  • 1984
  • $89
  • 1983
  • $76
  • 1982
  • $65
  • 1981
  • $51
  • 1980
  • $45
  • 1979
  • $40
  • 1978
  • $36
  • 1977
  • $31
  • 1976
  • $26
  • 1975
  • $23
  • 1974
  • $21
  • *Coinsurance was not charged for inpatient hospital care in calendar year 1989 due to Catastrophic Coverage; the deductible was applied.
  • B. Lifetime reserve coinsurance
  • The beneficiary is responsible for a daily coinsurance amount of one-half of the inpatient hospital deductible for each of the lifetime reserve days (the 91st through the l50th day) used in a benefit period.
  • The following chart shows the lifetime reserve day coinsurance amounts for benefit periods beginning in each year since 1974:
  • Year in Which Benefit Period Began
  • Coinsurance Amount
  • 2018
  • $670
  • 2017
  • $658
  • 2016
  • $644
  • 2015
  • $630
  • 2014
  • $608
  • 2013
  • $592
  • 2012
  • $578
  • 2011
  • $566
  • 2010
  • $550
  • 2009
  • $534
  • 2008
  • $512
  • 2007
  • $496
  • 2006
  • $476
  • 2005
  • $456
  • 2004
  • $438
  • 2003
  • $420
  • 2002
  • $406
  • 2001
  • $398
  • 2000
  • $388
  • 1999
  • $384
  • 1998
  • $382
  • 1997
  • $380
  • 1996
  • $368
  • 1995
  • $358
  • 1994
  • $348
  • 1993
  • $338
  • 1992
  • $326
  • 1991
  • $314
  • 1990
  • $296
  • 1989
  • $0 *
  • 1988
  • $270
  • 1987
  • $260
  • 1986
  • $246
  • 1985
  • $200
  • 1984
  • $178
  • 1983
  • $152
  • 1982
  • $130
  • 1981
  • $102
  • 1980
  • $ 90
  • 1979
  • $ 80
  • 1978
  • $ 72
  • 1977
  • $ 62
  • 1976
  • $ 52
  • 1975
  • $ 46
  • 1974
  • $ 42
  • * Coinsurance was not charged for inpatient hospital care in calendar year 1989 due to Catastrophic Coverage; the deductible was applied.