Parts of Medicare

Medicare Part A covers inpatient hospital stays, skilled nursing facilities, hospice, and home care. Part A is offered directly through Medicare usually with no cost.

A

Hospital Benefits:
Days 1-60 - You pay a deductible of $1484.00*

*This is a benefit period deductible (If there are more than 60 days between hospital stays you will have a new deductible)

Days 61-90 - You pay $371.00/day
Days 91-150th day - You pay $742.00/day
After 151st day - You pay all charges

Skilled Nursing Benefits:
Eligible after a 3 day inpatient hospital stay
Days 1-20 - You pay $0.00
Days 21-100 - You pay $185.50 per day
After 100th day - You pay all charges

Hospice Benefits:
Medicare pays majority of all costs except for a small co-pay or coinsurance

Home Care Benefits:
Medicare pays all approved costs

Lab Benefits:
Medicare pays all approved costs

Blood Benefits:
You pay the first 3 pints of blood,
Medicare pays all charges thereafter

Medicare Part A

Coverage for Hospitals and Facilities

Medicare Part B helps cover medically necessary doctors' services, outpatient care, home health services, durable medical equipment, preventative services and much more. Part B is offered directly through Medicare with a base cost of $148.50 per month.

B

You have an Annual Deductible of $203.00.

Medicare pays 80% of approved charges,
you pay 20% of approved charges.

If the doctor does not accept Medicare assignment, you may pay up to an additional 15% above the amount approved by Medicare.

All services must be approved by Medicare to receive coverage. Some
preventative care is paid at 100% by Medicare, like screenings and annual wellness exams.

Medicare Part A

Coverage for Hospitals and Facilities

Medicare offers prescription drug coverage to beneficiaries through private insurance companies that are approved by Medicare. Plans change annually and can be purchased as a stand-alone policy or included in a Medicare Advantage Plan. Costs of these plans vary by insurance carrier.

D

Depending on the plan you choose, you will pay an annual deductible between $0.00 - $445.00. Part D coverage occurs in 3 stages:

1) Initial Coverage Stage

You will then pay a co-pay or coinsurance determined by the company in a form of tiers. Tiers are usually 1-5.

2) Coverage Gap

Once the total cost of drugs reaches $4130.00, you will enter the coverage gap or "donut hole". You will pay 25% of brand and 25% of generic name medications.

3) Catastrophic Coverage

The Catastrophic stage is when out-of-pocket costs reach $6550.00. The maximum you will pay is 5% of the cost of the prescription.

Other Considerations

All Insurance Companies have a formulary, or medications list. This determines what company will cover and what tiers the medication will be under. They also restrict coverage with several requirements:

1. Quantity limits
2. Prior authorization
3. Step therapy

Medicare Part D

Prescription Drug Coverage