Here is what Medicare Part A Hospital Insurance covers:

• Inpatient Hospital Care
• Skilled Nursing Care
• Stays at Skilled Nursing Facilities (short-term)
• Home Health Care
• Hospice Care

In addition:

• Part A also includes inpatient care in a religious non-medical health care institution.
• Blood is also a Part A covered service. You will have to pay for the first three units of blood that you use. However, if the blood is donated free to the hospital or donated to you, then you do not have to pay for it.

What Medicare Part A Will Not Cover

Medicare Part A or Part B will not cover custodial, long-term care, nursing home or assisted living facilities. Click here to read more about ways to cover these costs.

Will Medicare Cover My Costs?

• If you have a specific procedure you want to look into, you can use the CMS’s government search tool here.

• Additionally, the Government has an app for coverage questions! You can find it on Google Play, or on the Apple App Store. “What’s Covered” is the name of the app in each store.

• Finally, you can use the Medicare and You Guidebook. CMS produces it every year. So, you can see what Part A covers and does not cover. In addition, you can see coverage for any other part of Medicare there too.

How Do I Know if I am Signed-up for Medicare Part A?

Part A and B are separate in Original Medicare, and you can be signed-up for one and not the other. First, to see if you are signed-up for Part A, you can check your Medicare Card. If you are signed-up, it will say “Hospital” and then have an effective date listed right on the card.

In addition, if you are a part of a Medicare Advantage Program, they you are also already signed-up for Part A. This is a prerequisite for join a Medicare Advantage (aka Part C) plan.

For More on What Medicare Part A Covers & the Other Parts of Medicare

Please Read:

• The Four Parts of Medicare Explained
• The Medicare and You User Guide
• Does Medicare Cover Hearing Aids?
• What is Medicare Advantage?
• What are Medicare Supplements (Medigap) Plans?

The post What Medicare Part A Covers appeared first on Medicare Life Health.

The Medicare Donut Hole (or Doughnut Hole) is a coverage gap in the Part D Prescription Drug Plan where beneficiaries could pay more for their drugs.

The Center for Medicare and Medicaid Services (CMS) calls the coverage gap a “temporary limit” on what their drug plan will cover.

Why Did My Drugs Get More Expensive this Month?

During Medicare’s Annual Enrollment Period (AEP) this year I was stationed at a pharmacy a few hours a week to answer people’s questions.

One gentleman came up to me and said, “The Pharmacist sent me over to you to ask you: Why did my drugs cost more this month? I get the same drugs each month, but this month, they cost me more!”

Yes sir, you have reached the Medicare Donut Hole in your Part D Prescription Drug Coverage. It was November, and this gentleman had been able to make it his other five years on Medicare without reaching the coverage gap.

However, this year, his drug costs were a little higher, and he hit the gap before the end of the year.

Will I hit the Coverage Gap?

The price changes in the coverage gap can be a shock if you have not experienced it before. So, let’s go over a little more information to prepare you for what might come.

When Does the Donut Hole Begin?

In 2020, the Part D Coverage Gap begins when you and your plan have spent $4,020 on prescription drugs. (In 2019, it was $3,820.) Thus, if you only spend $1,000 a year on drugs, the donut hole will not affect you.

When Does the Donut Hole End?

In addition, you may be wondering, when does medicare donut hole end? It ends once you and your drug plan have spent $6,350 in 2020 ($5,100 in 2019). You are then out of the coverage gap and have entered into Catastrophic Coverage.

During Catastrophic Coverage you will pay a much smaller amount of money for your drugs. This includes smaller co-insurances and smaller co-payments for the rest of the calendar year.

What am I Paying in the Coverage Gap (Medicare Doughnut Hole)?

As of 2020, Medicare will pay for 75% of BOTH brand name and generic drugs in the coverage gap. As a result, you will pay 25% of the cost of your drugs in the coverage gap.

There are some Medicare drug plans that includes coverage in the gap. According to CMS, ” you may get a discount after your plan’s coverage has been applied to the drug’s price. The discount for brand-name drugs will apply to the remaining amount that you owe.” You will need to speak to your plan to learn more.

What Costs Counts Towards the Coverage Gap?

Here are the costs that apply to your out-of-pocket expenses:

• First, Your Annual Drug Plan Deductible
• Second, Your Co-insurance and Co-Payments
• Third, Your Discount on Brand-name Drugs in the Donut Hole Coverage Gap
• Finally, Your Costs in the Coverage Gap

Here is what does not apply:

• Your Plan Premiums
• Any Pharmacy Dispensing Fees
• Any Drugs Not-Covered by Medicare Part D

Need More Information on Part D Drug Coverage?

• Start with our Simple Introduction to Part D Coverage here.

• Read about late fees and penalties that may apply to Part D here.

• Need to Switch your Drug Plan? You can do this during Annual Enrollment Period (AEP) each year.

• Or, just start at the beginning, with “What is Medicare?” to get an overview of the Medicare Program.

For Part D Sign-up Assistance

• Finally, if you are just aging into Medicare and need a Drug Plan.
  • Contact us here if you live in Nebraska or Iowa.
  • Or, find an agent here for other states.

The post What is the Medicare Donut Hole? appeared first on Medicare Life Health.

Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and it’s basic components, you will want to know how much does Medicare cost? The answer is, it depends on how you structure it. Let’s break down what you could be paying.

Medicare Costs Broken Down & Made Simple

When you set up your Medicare, you will decide if:

• You just want Original Medicare (Parts A & B) and a Prescription Drug Plan (Part D).
• You want Original Medicare plus a Medigap Plan (Aka a Medicare Supplement) and a Prescription Drug Plan.
• Or you want a Medicare Advantage Plan (Part C) that may or may not include a Prescription Drug Plan.

Your costs will also be different if you get help in any way from any state or federal programs.

How Much Original Medicare Costs

• Medicare Part A – For most people, there is not a cost or premium you pay for Part A. Your Part A is premium free if you worked in the US and paid Medicare taxes for at least 30 quarters. (You will pay up to $471 a month depending on your work history for Part A if you do not meet the premium free requirements in 2021).
  • There is also a $1,484 yearly deductible for Part A services and coinsurance tiers on hospital stays.
• Medicare Part B – You will pay a premium for Part B. In 2021, the standard premium is $148.50 per month. If you make more than $85,000 a year in retirement, you will pay more on an income dependent scale.
  • There is also a $1203 Part B deductible and a 20% coinsurance (co-pay) for most approved services.
  • Late penalties may also apply to Part B (and less commonly, Part A) if you do not sign-up when you are first eligible.

How Much Prescription Drug Costs

Medicare Part D – Prescription Drug Coverage needs to be obtained from a private insurance company. Each company will price their service differently and you can shop for the best plan and price for you. In addition, you will pay more for your Part D coverage, on a sliding scale, if you make more than $85,000 a year while on Medicare.

• Other costs to consider with your Part D coverage are co-pays and coinsurance, in addition to deductibles.

• Click here to learn about “What is the Medicare Donut Hole?“

• There are also late enrollment penalties associated with not signing up for Part D coverage when you are first eligible if you do not have “credible coverage.”

How Much Medicare Supplements or Medicare Advantage Plans Cost

On top of your Original Medicare, you will need to make a decision to either participate in a Medicare Advantage (Part C) plan or to consider having a Medigap (Medicare Supplement) Plan. If you need help deciding on which one is best for your needs, please read our article on Medicare Advantage Vs. Medicare Supplements.

• Medicare Supplement Plan Costs – Medicare Supplements will each have a different cost depending on the Letter Plan you choose and the company you go with. The government decides what benefits are offered by each letter plan. Then, each private insurance company decides what price they can offer for each plan in each market. It is a good idea to compare multiple plans by multiple carriers (insurance companies) in your area before choosing a plan. An independent insurance agent will be able to help you do this.
• Here are a Few Medigap Articles to tell you more:
  • What is Medicare Plan F?
  • Is Medicare Plan F Going Away?
    
• Medicare Advantage (MA/MAPD) Costs – Part C, or Medicare Advantage Plans are also offered by private insurance companies and stand in place of Original Medicare. In addition, they often include Part D Prescription Drug Coverage. Some of these plans have low or zero premium plan options. A few even cover Part B premiums. All of them are required to have max out of pocket expenditures and deductibles. It is a good idea to talk to an independent insurance agent on MAPD plans in your area to help you choose your best option.

Coverage Questions

If you are considering a specific procedure, you many have questions about what Medicare covers, and what costs are associated with each service or procedure. Here are a few health care costs to consider in regards to how Medicare will cover them:

• Ambulance Rides

• Chiropractic Care

• Acupuncture

• Dentures

• Cataracts

• Rehab

Medicare Costs Summary

In summary, Medicare will cost you something, unless you are on full benefits from Medicaid. Moreover, you have already been paying into the Medicare system during your working career with Medicare taxes. Common set-up for Medicare beneficiaries include:

• Having Original Medicare, Part A Premium Free, Part B Premium at $135.50 /month and a stand alone Part D Premium to pay. Then, adding on a Supplement Plan to cover the expenses Original Medicare does not pay.
• Or having a Part C Medicare Advantage Plan that includes a drug plan with a premium to pay (sometimes a $0 premium). Most commonly, you will still pay your Part B premium with Medicare Advantage.

Get More Help Understanding How Much Medicare will Cost You

One good resource for learning more about the costs of Medicare is the Medicare and You Book published by the government every year. It is a large book, so please star with our Medicare and You User’s Guide to learn what it offers and to get a copy if you need one.

In addition, finding the best Medicare options for your budget can be a lot to take on, but hopefully this breakdown is helpful. I strongly suggest talking to a professional to help you in setting up your Medicare plan. As an independent agent myself, I suggest using an independent agent. They are not tied to one company, so they work for you, not one carrier and can help you in considering many different carriers and plans.

As always, if you live in Nebraska or Iowa, please give me a call, and I can help you out either in person or over the phone.

Carly Cummings, NE/IA Licensed Independent Insurance Agent for Life and Health.

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