THE DIFFERENT PARTS OF MEDICARE
MEDICARE BROKEN DOWN
Updated June 2021
A QUICK BREAKDOWN
$0.00 monthly premium if you have worked 10 years in your lifetime. Part A is going to cover Inpatient Hospitalization and Skilled Nursing facilities. If you go into the hospital, there is a deductible of $1484.00. The first 60 days of hospitalization, Medicare will cover 100% of the cost, except for the telephone and television. If you are in the hospital longer than 60 days, your costs are as follows:
Days 61-90 $371.00 per day.
Days 91-150 $742.00 per day.
Medicare will cover 150 days of hospitalization. After your 150 days has been met, then you are responsible for all costs unless you have a supplement or something to pick up what Medicare does not.
If you have to go into a Skilled Nursing Facility Medicare will cover the first 20 days, for days 21-100 you will have a $185.50 per day copay unless you have additional insurance.
The monthly premium for Part B for someone new to Medicare is $148.50 per month and will be drafted directly out of your Social Security Check. Part B covers doctor's visits, out-patient procedures, emergency room visits where you are not admitted into the hospital, other things as well. Part B has an annual deductible of $203.00 for 2021 and after the deductible has been met the insurance becomes an 80/20. Medicare will cover 80% and you will be responsible for the other 20%. There is no cap on the amount you could owe! There are options available to make sure you do not have to come up with the 20%, or even the Part B deductible.
This is Part A & B in a nutshell. This is known as traditional Medicare. The great news about traditional Medicare is that there are no networks. If the doctor takes Medicare, you can go see him. You do not need a referral, and your care is between you and your doctor. You are in more control of your Health decisions.
The monthly premium of Part C is anywhere from $0.00 per month all the way up to $125.00 per month. This is going to depend on which Company and Plan you go with for your Part C coverage. This is in addition to the Part A & B premiums. You must maintain Parts A & B in order to get a Medicare Advantage Plan. You do not have to get a Part C. I am explaining all of the Parts so you can make the best decision for you.
Part C, or Medicare Advantage, is a privately managed Medicare Plan. If you decide to get a Part C, you forfeit your rights to Medicare for a year, and you are locked into it for the whole year.
Instead of giving the doctor your Red, White, and Blue Medicare card, you would give them your new insurance card. Some of these plans come with a prescription plan and some also come with Dental and Vision coverage as well. The Dental and Vision is very limited.
Part C works like traditional insurance. It does have a maximum out of pocket of up to $7550.00 and that is per year. There are networks and depending on which plan you choose, you could be on the hook for most, of if not all, of the cost of treatment. You also have to get referrals and pre-authorization for a lot of your treatments, again, depending on which policy you get for coverage. This is not traditional Medicare and you do not have to enroll in Part C if you wish to get a Supplement to offset the costs of Medicare coverage.
You can get Parts A & B, purchase a supplement, and get Part D coverage.
You may also maintain Parts A & B, and go with a Part C.
Prescription Plan, or Part D
will be $445 in 2021.
Initial Coverage Limit (ICL):
will be $4,130 in 2021.
Out-of-Pocket Threshold (or TrOOP):
will be $6,550 in 2021.
Coverage Gap (Donut Hole):
begins once you reach your Medicare Part D plan’s initial coverage limit ($4,130 in 2021) and ends when you spend a total of $6,550 out-of-pocket in 2021.
2021 Donut Hole Discount:
Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% you pay, count toward your TROOP or Donut Hole exit point.
For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2021 total out-of-pocket spending limit.
Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
beneficiaries will be charged $3.70 for those generic or preferred multisource drugs with a retail price under $72 and 5% for those with a retail price greater than $72. For brand-name drugs, beneficiaries would pay $9.20 for those drugs with a retail price under $179 and 5% for those with a retail price over $179.
Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
will increase to $3.70 for generic or preferred drug that is a multi-source drug and $9.20 for all other drugs.
These are the Parts to Medicare, please let me know if you have any questions.
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By providing the information to the right, you understand that a licensed insurance agent may contact you via phone, email or mail regarding Medicare Supplement Insurance Plans and/or Medicare Part D Prescription Drug Plans.