When you’re choosing Medicare coverage, you’re likely deciding between:

• Original Medicare (Part A and B)
• Medicare Part D (by itself or added onto another Medicare plan)
• Medicare Advantage

Your choices influence the costs, extent of coverage, and where you can get it.

Costs

Medicare plans have a combination of all or part of the following: deductible, coinsurance, copay, and premium.

Original Medicare deductibles:

• Part A – $1,484 once per benefit period
• Part B – $203 annually

Part D deductibles:

• Varied; no plan can exceed $445 per year

Medicare Advantage deductibles:

• Typically no deductible with rare exceptions

Original Medicare coinsurance:

• Part A – $0 coinsurance for the first 60 days; $371 per day between 61 and 90 days, $742 daily from days 91-150, and all costs if more than 150 days
• Part B – Medicare covers 80% of the bill; you pay 20%

Part D coinsurance:

• Copay plans only with exception of Coverage Gap where you are responsible for 25% of the cost of the drugs until you hit $6,550 in out-of-pocket costs (after this you go to a catastrophic copay stage) 

Medicare Advantage coinsurance:

• Typically only applies to PPO plans when obtaining services out of network.

Copayments:

• All copayment amounts for each plan are determined by the insurer

Original Medicare premiums:

• Part A – premium-free if you have worked your required 40 quarters (paid your Medicare Taxes); $259 – $471 monthly if not eligible for premium-free version
• Part B – $148.50 monthly

Part D premiums:

• Varies as the plan should be based on your personal prescription needs; the average cost is roughly $33.06 per month

Medicare Advantage premiums:

• Varied monthly premiums from $0 to $180 or more depending on your county and coverage provided within the plan.

Coverage Provided

Original Medicare covers any service you get as an inpatient that is a medical necessity. For outpatient coverage, you get coverage for preventive services, specialists, immunizations, and durable medical equipment.

Part D offers coverage according to its list of covered medications, known as the formulary. The amount you pay out-of-pocket is determined by tier. Tiers indicate cost amounts and are numbered based on whether the drug is Preferred Generic, Generic, Preferred Brand, Non-Preferred specialty drugs. These are numbered 1-5, respectively.

Medicare Advantage provides the same coverage as Original Medicare, with additional services previously mentioned. Some plans offer lower costs for seeing certain providers within the plan’s network.

Coverage When Traveling

Original Medicare covers you in any healthcare facility in the US that accepts Medicare. For coverage when traveling abroad, you can enroll in a Medicare Supplement plan that provides 80% coverage for foreign travel emergencies with a lifetime limit of $50,000.

Some Medicare Part D plans offer the ability to refill your prescriptions nationally while traveling.  The cost could vary significantly while traveling versus being in your plan’s designated service area.

As for Medicare Advantage, most plans require treatment within the plan’s provider network. However, some plans such as Preferred Provider Organizations and Private Fee-for-Service Plans allow for out-of-network coverage.

Give Us A Call Today To Learn More!

At Eldridge Agency, we work hard to get you the policy that best suits your needs. We consider your needs and all options available to you, which will lead to you getting the best Medicare plan for your money!