Here is the breakdown of the four parts to Medicare. These are known as Parts.
$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 $1364.00. 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 $341.00 per day.
Days 91-150 $682.00 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 $170.50 per-day copay, unless you have additional insurance.
The monthly premium for Part B for someone new to Medicare is $135.50 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 $185.00 for 2018 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. Dental and Vision is very limited.
Part C works like traditional insurance. It does have a maximum out of pocket of up to $6700 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
Part D is going to cost anywhere from $14.00 per month to $125.00 per month. The medications you take are going to determine which Part D plan is right for you. Part D is governed by Medicare but it is administered by a private insurance company. Please keep in mind in most circumstances you will be enrolled in your Part D plan for the whole year. Part C & Part D are the plans being talked about for the Annual Enrollment Period. This is from 10/15 until 12/07 every year. During this time you can switch plans for the following year.
Most of your Part D plans are going to have a deductible of up to $405.00 per year. The first $3750 in costs, not including your monthly premium, your copays will be anywhere from $0.00-33% of the prescriptions costs. Tier 1,2 and 3 are going to have a reasonable copay. Tier 4 and 5 prescriptions could require you to pay up to 33% of the prescriptions cost.
After $3850.00 has been met, this is the total you and the insurance company have paid, you will enter the Donut Hole portion of coverage. This is the Part of Part D that most people dread. From $3851.00 until $8850.00 you will 40% of the prescription's cost. The insurance will pay 40% and Medicare will pay 10%. This number is figured by adding your portion of the copay, the insurance company's portion, and the government's as well.
After total copayments have reached $8850, you enter Catastrophic coverage. This is for the rest of the year and you will pay the greater of 5% or $3.35 for the generic and the greater of 5% or $8.85 for name brand prescriptions.
These are the Parts to Medicare, please let me know if you have any questions.
Randall J. Lawson
The HgO Group
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