Your transition into Medicare coverage can be quite intimidating. But it doesn't have to be - just give us a call! Within a few quick minutes, one of our Medicare-specific, Virginia resident agents can help you understand your options so that you can make the most informed decision. We will also help facilitate your application for coverage by shopping dozens of insurance plans in the Supplement and Part D markets based on your age, zip code and household status, prescription list, and pharmacy preference. What could be better?
Part A of Medicare usually has no premium cost and provides coverage primarily for inpatient hospital and inpatient skilled nursing facility care. Part A has a benefit period deductible of $1,340 for hospital inpatient and a SNF co-insurance of $167.50 per day for days 21-100 (2018). Due to these out-of-pocket costs, many choose to add a Medicare Supplement policy to coordinate with Part A benefits (see "Supplement" on this page for more information).
Part B of Medicare has a varying premium based on when you retired and your retirement income amount. Most new retirees pay $134/month in premiums (2018). Part B covers outpatient services such as physician appointments, labs, radiology, chemotherapy, etc. Part B has an annual deductible of $183 (2018) and usually pays 80% thereafter, leaving 20% co-insurance to the beneficiary. The biggest "gap" in Part B is that there is no out-of-pocket maximum that limits the 20% co-insurance. Adding a Supplement to your Part B reduces or eliminates most of your out-of-pocket expenses.
Part C is optional coverage that REPLACES your Parts A and B and sometimes D with coverage through a private insurance company. Many Part C plans are either PPO or HMO that might limit provider choices more than original Medicare. Part C plans also have out-of-pocket expenses that differ broadly from original Medicare coverage and might include Part D prescription coverage. If you want to consider a Part C plan, be sure to review the "Summary of Benefits" and Provider Directory closely before making an enrollment decision. Part C plans may also have a monthly premium in addition to your Medicare premiums.
Part D of Medicare covers outpatient prescription drugs and is administered by any number of different private insurance companies. These plans run by the calendar year and you are able to change plans during the annual enrollment period of Oct. 15 - Dec. 7 each year with coverage taking effect on January 1. Plans vary by premium rates, co-pay amounts, deductibles, pharmacy participation, and which prescriptions they cover and at what co-pay tier. The website is a great resource to identify the appropriate plan for your specific drug list and pharmacy preference.
While Plan F is best, Plans G and N provide quite comprehensive benefits at a substantially lower premium. Plan G simply leaves you to pay the $183 (2018) Part B deductible. Plan N, in addition to the deductible, requires you to pay a physician co-pay up to $20 and ER co-pay up to $50 - that's it!
While the chart to the right states the out-of-pocket limit as "none" for most plans, there is generally no out-of-pocket for any services that Medicare approves of except as expressed in the chart.
Be sure to ask our Medicare team member to price quote each of the plans that you might be interested in coverage.
** Plan N has $20 physician and $50 ER copay after Part B deductible is satisfied.
Out of Pocket limits for plans K and L increase annually with inflation adjustment.
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