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Part B is mostly financed by general revenues and beneficiary premiums. Enrollees in Medicare Cost plans can join if they carry Original Medicare or just Medicare Part B. This hybrid plan gives beneficiaries the option to go to out-of-network providers on a fee-for-service structure (including the expense of Part A and Part B deductibles and coinsurance). Medicare has, and continues to undergo, changes under the PPACA health care reform laws of 2010, including new policy options such as Medicare Advantage, and coverage such as free preventive care services – but beneficiaries have seen, and will see, changes in out-of-pocket expenses, such as deductibles and payroll taxes. Under PPACA in 2013, the Additional Medicare Tax, generally withheld from high-wage earners, was introduced. In 2019, 34 percent of all Medicare beneficiaries were enrolled in a Medicare Advantage plan. In 2019, the gross monthly income limit for qualified Medicare beneficiaries in most states was $1,061 for individuals and $1,430 for couples, while the asset limits were $7,730 for individuals and $11,600 for couples. Individuals younger than 65 may be eligible for Medicare’s hospitalization insurance benefits, either subsidized or as an out-of-pocket monthly expense, if they’re diagnosed with end-stage renal disease (ESRD) or a qualifying long-term disability.

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