US · guidance
CMS Pub. 100-01, ch. 3, § 10.3
Basis for Determining the Part A Coinsurance Amounts
The applicable inpatient deductible is the one in effect during the calendar year in which the patient's benefit
period begins (i.e., in most cases, the year in which the first inpatient hospital services are furnished in the
benefit period). Except for 1989, the coinsurance amount is based on the deductible applicable for the
calendar year in which the coinsurance days occur.
When Deductible and/or Coinsurance Are Applicable for Part A
Inpatient Hospital- First 60 Days Deductible applicable equal to national average cost per
day
Inpatient Hospital- 61st thru 90th Day Coinsurance per day always equal to 1/4 of inpatient
hospital deductible
Inpatient Hospital- 60 Lifetime Reserve Days
(nonrenewable) - 91st thru 150th day
Coinsurance always equal to 1/2 of inpatient hospital
deductible
Skilled Nursing Facility
21st thru 100th Day
Coinsurance always equal to 1/8 of inpatient hospital
deductible
Home Health Agency No Deductible No Coinsurance (except for 20 percent
coinsurance for DME and prosthetics/ orthotics)
Blood 1st 3 pints (or equivalent units of packed red blood cells)
in a calendar year - combined Part A and B
Hospice *
a. Drugs and Biologicals
b. Respite Care
a. 5 percent of the cost determined by the drug copayment
schedule (may not exceed $5 per prescription)
b. 5 percent of the payment for a respite care day
*Hospices may charge coinsurance for two services only, drugs and biologicals, and respite care. The
amount of coinsurance for each prescription may not exceed $5.00. The amount for respite care may not
exceed the inpatient deductible for the year in which the hospital coinsurance period began.
Deductible and Coinsurance Amounts
Year Part A
Deductible,
1st 60 Days
Part A
Coinsurance,
61st- 90th Days
Part A
Coinsurance,
60 Lifetime Reserve
Days
Part A
SNF Coinsurance
21st- 100th Days
1986 $492 123 246 61.50
1987 520 130 260 65.00
1988 540 135 270 67.50
1989 560 0 (1) 0 (1) 0(2)
1990 592 148 296 74.00
1991 628 157 314 78.50
1992 652 163 326 81.50
1993 676 169 338 84.50
1994 696 174 348 87.00
1995 716 179 358 89.50
1996 736 184 368 92.00
1997 760 190 380 92.00
1998 764 191 382 95.50
1999 768 192 384 96.00
2000 776 194 388 97.00
2001 792 198 396 99.00
2002 812 203 406 101.50
2003 840 210 420 105.00
2004 876 219 438 109.50
2005 912 228 456 114.00
2006 952 238 476 119.00
2007 992 248 496 124.00
2008 1,024 256 512 128.00
2009 1,068 267 534 133.50
2010 1,100 275 550 137.50
2011 1,132 283 566 141.50
2012 1,156 289 578 144.50
2013 1,184 296 592 148.00
2014 1,216 304 608 152.00
2015 1,260 315 630 157.50
2016 1,288 322 644 161.00
2017 1,316 329 658 164.50
2018 1,340 335 670 167.50
2019 1364 341 682 170.50
2020 1,408 352 704 176.00
2021 1,484 371 742 185.50
2022 1,556 389 778 194.50
2023 1,600 400 800 200.00
2024 1,632 408 816 204.00
2025 1,676 419 838 209.50
1. Coinsurance was not charged for inpatient hospital care in CY 1989 due to
Catastrophic Coverage. The deductible was applied.
2. Under Catastrophic Coverage, a coinsurance payment of $25.50 was due for
days 1-8 of SNF care. No SNF coinsurance was due after day 8 in 1989.
History
(Rev. 12980; Issued:11-25-24; Effective: 01-01-25; Implementation: 01-06-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9f319ea97e374149b55bdb907436e5fd2830c4599ace3e58f5447a66d4106c7b
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