Call to speak to a Licensed Insurance Agent
The chart below offers a basic coverage view of all Medicare Plans, including Advantage and Medigap policies.
Remember, Original Medicare consists of Plans A and B, while Medicare Advantage is Part C, and often covers many of the gap or supplemental needs you might have.
If you get Medicare Part C (Advantage), you’re not eligible for the supplemental options (because they’re covered under C).
Once you’ve reviewed the data and have a better idea of what plan options might be better for you, you can visits the Medicare.gov website to search for available plans in your area.
|Part A Premium
|Essentially, if you or your spouse worked for longer than 10 years, you have a $0 premium cost. However, if you or your spouse worked less than 10 years, you will have to pay a monthly premium.If your time worked was between 7.5 and 10 years, you will pay a monthly premium of $240. If you worked for fewer than 7.5 years, you will pay a monthly premium of $437.
|Part A Deductible
|Hospital Stay: The cost depends on how long you stay. If you stay is 60 or fewer days, you pay $1,364 deductible, then nothing.
Skilled Nursing Facility: None (Must Meet Requirements)
Home Health Care: None (Must Be Doctor Approved)
|Part A Copayments
|Hospital Stay: If your stay is 61-90 days, you will pay an additional $341 per day. If your stay goes to 91-150 days, it will cost $682 per day. If your stay exceeds 150 days, you will pay the full cost of your hospital stay.
Skilled Nursing Facility: If your stay runs longer than 20 days, you’ll pay a premium of $170.50 per day for days 21-100, then all costs after day 100.
Home Health Care: None (Must Be Doctor Approved)
|Part B Premium
|There is a monthly premium associated with Medicare Part B. For individuals making less than $85,000 OR couples making less than $170,000, the monthly premium averages around $135. For those with higher incomes, the cost can range as high as $460 per month.
|Part B Deductible
|You will pay an annual deductible of around $185 for Medicare Part B. Low income individuals may be eligible to waive this yearly cost.
|Part B Coinsurance
|Once your deductible is met, you will pay 20% of approved Medicare Part B services.
Make Sure Your Health Care Providers Accept Assignment!
This crucial to keeping your Medicare Part B costs down. You will want to make sure your doctor(s)/providers will “accept assignment,” essentially they will agree to accept the amount that Medicare will pay for a visit or service as payment in full. If you provider or doctor will not accept assignment, they can charge you more, up to 15% more than the Medicare Approved Amount!
Make Sure Your Doctor/Provided Hasn’t Opted Out Of The Medicare Program
Providers can opt out of the Medicare program. These providers can charge whatever they want for visits or services and Medicare will simply not cover them. Providers should have you sign a contract that states this.
|Plan C (Advantage)
|Part C Premium
|Premiums for Medicare Part C will range from $0 to $200, with the average monthly premium coming in around $30. You will pay your Part B premium plus any additional required premiums. Some Medicare Advantage Plans may pay for part of Part B, so check you plan.
|Part C Deductible
|Only a few Part C plans have annual deductibles.
|Part C Copayments
|Copayments are typically a set dollar amount, based on specific services or visits.
These are changed yearly, and have different rules, based on your medical needs, so make sure you stay on top of these costs. Currently, the max for out of pocket spending is $6,700 for in-network providers. This cost may go higher if you use out-of-network services or providers.
|Part D Premium
|The current average monthly premium for Medicare Part D is about $33. This rate will vary depending on the plan you choose and where you live.
|Part D Deductible
|Part D deductible plans range from $0 to $415. Do your homework to factor yearly costs with the drugs that you will need to take before selecting your premium plan.
|Part D Copayments/Coinsurance
|A coinsurance is a percentage of the price of your prescription. A copayment is a fixed dollar amount for your prescription. You will typically have to pay coinsurance on drugs in higher tiers, with lower tier drugs sticking with a copay pricing model.
Will Medicare Part D Stop Paying For My Drug Costs?
Unfortunately, yes. Called the coverage gap or donut hole, you will be responsible for 25% of all your drug costs when you reach a limit of about $4,000 in yearly drug costs. However, once you’ve paid over $6,350 for out-of-pocket drugs costs, you leave the gap/donut hole coverage and enter catastrophic coverage.
|Plans F/G/K/L/M/N (Medigap)
|If you have a Medicare Advantage Plan (Part C Medicare) you are NOT eligible for Medigap. Medigap helps pay for Medicare deductibles and copays you would otherwise have to pay out of pocket. While there are numerous companies that sell Medigap plans, they all MUST sell the exact same benefits or standard benefits of each plan. Even though the benefits are the same, different insurance companies charge different rates for the same plan. Expect an average of around $150/month.
|Again, these will vary per state and impact your monthly premium. You can select high deductible plans and vice versa. Make sure you plan out your medical care needs and shop accordingly. If you don’t require a lot of medical attention, a high deductible plan might be a good option, if not, a lower deductible plan, and so on.
|Again, this will vary by plan, state, etc.