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Medicare Supplement
Insurance
...because Medicare
can't do the whole job. |
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Medicare Part A |
Medicare Part B |
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2007/2008
Part A
is Hospital Insurance covering
costs
associated with confinement in a
hospital
or skilled nursing facility. |
2007/2008
Part B is Medical Insurance covering
physician services, outpatient care,
tests and supplies. |
|
When you are
hospitalized for: |
Medicare Covers |
Patient Pays |
On Expenses
Incurred for: |
Medicare Covers |
Patient Pays
$131
$135
Annual Deductible PLUS: |
|
1 - 60 Days |
Most confinement costs after the required Medicare Deductible. |
$992.00
$1,024
Deductible |
Medical Expenses
Physician's services for inpatient
and outpatient medical/surgical services; physical/speech therapy,
diagnostic tests |
80%
of approved amount |
20%
of approved amount |
|
61 - 90 Days |
All
eligible expenses after the patient pays a per-day copayment |
$248.00
$256.00
a day copayment |
Clinical Laboratory Service
Blood tests,
urinalysis |
Generally
100% of approved amount |
Nothing
for
services |
|
91 - 150 Days |
All
eligible expenses after patient pays a per-day copayment. (Lifetime
Reserve Days which may never be used again.) |
$496.00
$512.00
a day
copayment |
Home Health Care
Part time or intermittent skilled care,
home health aide services, durable medical supplies and other services |
100%
of approved amount; 80%
of approved amount for durable medical equipment |
Nothing for services;
20%
of approved amount for durable medical equipment |
151 days
or more |
NOTHING |
Patient pays all costs. |
Outpatient Hospital Treatment
Hospital services for the diagnosis
or treatment of an illness or injury |
Medicare payment to hospital based on outpatient procedures payment rates |
Coinsurance based on outpatient payment rates |
Skilled Nursing Confinement
When you are hospitalized for at
least 3 days and enter a Medicare approved skilled nursing facility within
30 days after hospital discharge and are receiving skilled nursing care. |
All
eligible expenses for
the first 20
days; then all eligible
expenses
for days
21 - 100
after the
patient pays
a per day co-payment |
After 20 days
$124.00
$128.00
a day copayment |
Blood |
After first
3 pints
of blood
80%
of
approved
amount |
First 3 pints of blood plus
20%
of
approved
amount for additional
pints |
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Part B Premium |
- |
$93.50
$96.40* |
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*
2008 Medicare Part B Premiums
As directed by the 2003
Medicare law, for the first time, higher income beneficiaries will pay
higher Part B premiums. Following are the higher premium rates:
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Individuals with annual incomes between $82,000 and $102,000 and married
couples with annual incomes between $164,000 and $204,000 in 2008 will
pay a monthly premium of $122.20. |
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Individuals with annual incomes
between $102,000 and $153,000 and married couples with annual incomes
between $204,000 and $306,000 in 2008 will pay a monthly premium of
$160.90. |
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Individuals with annual incomes
between $153,000 and $205,000 and married couples with annual incomes
between $306,000 and $410,000 in 2008 will pay a monthly premium of
$199.70. |
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Individuals with annual incomes
of $205,000 or more and married couples with annual incomes of $410,000
or more in 2008 will pay a monthly premium of $238.40. |
Rates
differ for beneficiaries who are married but file a separate tax return
from their spouse:
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Those with incomes between $82,000 and $123,000 will pay
a monthly premium of $199.70. |
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Those with
incomes greater than $123,000 will pay a monthly premium of $238.40. |
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On all Medicare-approved expenses, a doctor or other health care provider
may agree to accept Medicare "assignment". This means the patient
will not be required to pay any expense in excess of Medicare's "approved"
charge. The patient pays only 20% of the approved charge not paid by
Medicare. Physicians who do not accept assignment of a Medicare
claim are limited as to the amount they may charge for covered services.
back to top
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Medicare Part D
New Optional
Prescription Drug Benefit
In January of 2006, the Medicare discount card
was phased out and replaced with Medicare Part D, a prescription drug benefit
option. Plans available must provide, at minimum, the benefits
illustrated below. Here's how it will work:
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|
Costs Incurred |
Your Medicare Part D
Plan
Will
Pay |
You Pay
|
Your
Out of Pocket
Expense
for the Year
|
Your Monthly Premium
|
Nothing |
$35*
(could be more
or less) |
420 |
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Your Annual
Deductible
$250 |
Nothing |
$250 |
420 + 250 =
670 |
|
Your Cost of
Drugs
From $251 to
$2,250 |
75% |
25% ($500) |
500 + 670 =
1,170 |
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Your Cost of
Drugs
From $2,251 to
$5,100 |
Nothing |
100% ($2,850) |
2,850 + 1,170
= 4,020 |
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Your Cost of
Drugs
In excess of
$5,100 |
The lesser of
95%
of the actual
costs
or the balance
of costs
after your
co-pay |
The greater of
5% of costs
or
a $2 Co-pay
for
Generic drugs
or
a $5 Co-pay
for
Brand-name
drugs |
$4,020 + Sum
of Co-Pays and/or 5% payments =
Your total
Out-of pocket expense for the year |
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Let’s put it in plain English! |
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1st |
Let's say your monthly premium for the optional prescription drug
benefit, Medicare Part D Plan, would be $35.00 (this will vary)* |
…so that’s $420 for the whole year… |
…so your total out of pocket expense if you don't spend a cent on
prescribed drugs would be $420 for the year in this example |
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2nd |
Your Annual deductible is $250 |
…so the first $250 you spend on Prescription Drugs comes out of
your own pocket… |
…so now your out-of-pocket expense is $420 for the premium plus
$250 for the deductible for a total of $670 for the year so far |
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3rd |
For the next $2,000 you spend on Prescription Drugs Medicare Part
D will pay 75% or $1500 of it… |
…so you will pay the other $500… |
…and now your total out of pocket expense is your premium of $420
plus your deductible of $250 plus this $500 which totals $1,170 so
far for the year |
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4th |
For the next $2,850 you spend on Prescription Drugs Medicare Part
D will pay NOTHING… |
…so this $2,850 comes out of your
pocket… |
…and now your total out of pocket expense is your premium of $420
plus your deductible of $250 plus the $500 from Step 3 and now
this $2,850 which totals $4,020 so far for the year |
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5th |
So
far a total of $5,100 has been spent for the year for Prescription
Drugs. For any additional purchases over this amount Medicare
Part D will pay up to 95% of the cost |
…and you will pay the higher of: A, B, or C below:
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A. |
$2 co-pay for
Generic Drugs |
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B. |
$5 co-pay for
Brand Name
Drugs |
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C. |
5% of the cost |
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…so now your total out of pocket expense is your premium of $420
plus your deductible of $250 plus the $500 from Step 3, the $2,850
from Step 4 which is $4,020 plus the sum of your share of the
costs for drugs purchased in excess of $5,100 as shown to the
left. |
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Here's another way to look at it:
Out-of-Pocket Drug Spending in
2006 for Medicare
Beneficiaries Under New Medicare Legislation |
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$420 Annual Premium
should be added to out-of-pocket spending. |
| Note: Benefit levels are
indexed to growth in per capita expenditures for covered Part D drugs.
As a result, the Part D deductible is projected to increase from $250
in 2006 to $445 in 2013; the catastrophic threshold is projected to
increase from $5,100 in 2006 to $9,066 in 2013.
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Below you can link to another Benefit
Calculator |
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back to top |
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The
12 Standardized Medicare Supplement Plans |
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Here's a quick look at the standardized
Medigap Plans A through L and their benefits.
Every insurance company must make Plan A
available if they offer any other Medigap policy.
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Basic Benefits Included in all
Plans
Hospitalization:
Part A coinsurance plus coverage for 365 additional
days after Medicare benefits end.
Medical Expenses:
Part B coinsurance (generally 20% of Medicare-approved
expenses).
Blood:
First three pints of blood each year.
How to Read the Chart
If a dot appears in the
column, this means that the Medigap policy covers 100% of the
described benefit. If a column lists a percentage, this means the
Medigap policy covers that percentage of the described benefit. If no
percentage appears of the column is blank, this means the Medigap policy
doesn't cover that benefit. Note: The Medigap policy covers
coinsurance only after you have paid the deductible (unless the Medigap
policy also covers the deductible).
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Medigap Benefits |
A |
B |
C |
D |
E |
F* |
G |
H |
I |
J* |
K |
L |
| Medicare Part A Coinsurance & Medigap Coverage for Hospital Benefits |
● |
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● |
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● |
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| Medicare Part B Coinsurance or Copayment |
● |
● |
● |
● |
● |
● |
● |
● |
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50% |
75% |
| Blood (First 3 Pints) |
● |
● |
● |
● |
● |
● |
● |
● |
● |
● |
50% |
75% |
| Hospice Care Coinsurance or Copayment |
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50% |
75% |
| Skilled Nursing Facility Care Coinsurance |
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● |
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● |
● |
● |
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50% |
75% |
| Medicare Part A Deductible |
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● |
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● |
● |
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50% |
75% |
| Medicare Part B Deductible |
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