Medicare and your options

Medicare is a great starting point for those over 65 and individuals on Social Security due to disability but it can leave the insured with many out of pocket costs.  An inpatient hospital stay has a deductable of almost $1,200 dollars.  Most retired people seldom have enough disposible assets to cover many hospital stays.  Both Medicare Supplement plans and Medicare Advantage plans can helpreduce your costs.  Prescription drug coverage is not included in original Medicare and must be obtained threough a private company.  The program is overseen by the federal Medicare program and the plans are referred to as Medicare Part D.

Check out your own options at Allboc.com. The sites full of details.

Where can I compare and apply for Medicare Advantage Plans?

One site you to can use to easily compare and apply for Medicare Advantage Plans is found here.

Where can I compare and apply for Medicare Prescription Drug Plans?

One site you to can use to easily compare and apply for Medicare Prescription Drug Plans is found here.

RELATED SUBJECTS:

Medicare Advantage Plans

Medicare Supplement Plans

Medicare Basics

Medicare Part D

Medicare Part D plans are the prescription drug plans designed to go with Medicare.  These plans follow a basic format dictated by Medicare.  Medicare recipients typically pay a premium ($15 to $100 depending on plan) for these plans unless the Part D portion is included with their Medicare Advantage Plan or the premium is paid for by Medicare/Social Security ("Extra Help" or Low Income Subsidy).  

Basic Structure:

Deductible:  plans may have a deductible of up to $325.

Initial Coverage:  plans set co-payments for generic, brand name, and specialty drugs.

Coverage Gap:  after you and the plan have paid a total of $2,970 since Jan 1, you begin to pay 79% for generic medications and 47.5% for brand name drugs.

Catastrophic Coverage:  after the amount you pay plus the manufactures discount equals $4,750, you pay the greater of $2.65 or 5% for generic medications and $6.60 or 5% for brand name medications.

Example 1

Mary has a plan with a $0 deductible.  She takes 4 medications which have a ful cost of $193 per month.  From January through December her total yearly drug cost will be 12 x 193 = $2,316. Mary will not reach the coverage gap and therefor will only pay the standard co-payments throughout the year.

Example 2

Robert has plan with a $325 deductible.  He will pay the deductible from his own pocket but will benefit because his plan has a very low premium and low co-payments.  Robert's typical monthly cost for medications is just $40.  He will pay the full $40 for his medications from January through August but in Sept he will have completed the deductible and will begin paying a small co-payment for his medications.  He will not reach the coverage gap phase because after the deductible, he and the plan did not pay more than $2.970.

Example 3

Paula takes some generic medications and some brand name medications.  In January, Paula pays $100 in co-payments and the insurance plan pays $230.  This will continue through September ($100 + $230 x 9 = $2,970).  for the months of October through December, Paula will pay 79% of the full cost for her generic medications and 47.5% for her brand name medications.

Example 4

Albert takes quite a few generic medications and some very expensive brand name medications.  The total cost for his medications is $3,000 per month.  He will pay co-payments in January but will be in the coverage cap phase in February.  Because the manufacturer's is discount is credited toward Albert's out of pocket costs, he will pay 79% for generic medications and 47.5% for brand names drugs during February and part of March.  When his percentage and the 50% manufacturer's discount for brand drugs totals $4,750, he will pay the greater of $2.65 or 5% for generic medications and $6.60 or 5% for brand name medications for the rest of the year.

 

Related Subjects:

Medicare Basics

Medicare Supplements

Medicare Advantage Plans

Medicare Supplement Plans

Medicare supplement plans are private insurance plans designed to pay the deductibles and 20% co-insurance that Medicare does not pay for doctor and hospital care.  A Medicare recipient must have both Part A and Part B of Medicare in order to have a Medicare Supplement plan.  In most states, a Medicare recipient may choose from several different supplements labeled Plan A through Plan N.  The premium for a Medicare Supplement s dependent on the amount of benefits in that plan.

Each company sets their own rates for their Medicare Supplement plans.  Every Plan A has the same benefits, every Plan F has the same benefits, etc.

Related Subjects:

Medicare Basics

Medicare Advantage Plans

Medicare Part D