Part A Deductible     $1632
Part B Deductible        $240
Co-payment for hospital stay days 61-90:    
$408/day
Co-payment for hospital stay days 91 and beyond: $816/day
Skilled Nursing Facility co-payments days 21-100:    $204/day

Part B Monthly Premium   $174.70
(File Ind. Tax return $103,000. or below)
(File joint tax return $206,000. or less)

Part B Monthly Premium   $244.60  
(File Ind. Tax return: $103,000. – $129,000.)
(File joint tax return: $206,000. – $258,000.)

Part B Monthly Premium   $349.40  
(File Ind. Tax return: $129,000. – $161,000.)
(File joint tax return: $258,000. – $322,000.)

Part B Monthly Premium   $454.20  
(File Ind. Tax return: $161,000. – $193,000.)
(File joint tax return: $322,000. – $386,000.

Part B Monthly Premium   $559.00  
(File Ind. Tax return: $193,000. – $500,000
(File joint tax return: $386,000. – $750,000.)

Part B Monthly Premium   $594.00  
(File Ind. Tax returns above $500,000.)
(File joint tax return above $750,000.)

Part B Monthly Premiums
Beneficiaries who are married but file a separate tax return from their spouse.

• $103,000. or below: $174.70               
• $103,000. – $397,000: $559.00              
• Above $397,000: $594.00