This article outlines Medicare coverage including Original Medicare Parts A and B; prescription drug coverage Part D; Medigap/Supplemental Insurance coverage; and Medicare Advantage.
What is Medicare Part A and B, and how much will I pay?
Part A is considered hospital insurance and covers in-patient care. There is no premium if you have 10 years of qualified work. For hospitalizations, a per episode deductible is in place for $1600 in 2023. Once met, days 1-60 are covered at 100%; then Medicare sets the coverage amount at days 61 and beyond.
Part B is considered medical insurance and covers physician services, outpatient care, home health care, and most infusion drugs, including factor. The average premium is $165 for 2023 and the deductible is $226. At that point, Part B pays 80%. Factor therapies fall under Part B coverage.
What is Medicare Part D and how much will I pay?
Part D is the prescription drug plan. Plan costs are based on income and range from $0-$77.90 with the average plan costing $43/mo. Your out-of-pocket costs depend upon your prescription as Medicare uses a tier system to determine patient cost. The yearly deductible before Medicare begins paying anything is $505 for 2023. When catastrophic coverage begins (at $7400 in shared costs), you will pay 5% of drug cost for the rest of the year.
What is Medigap and how much will I pay?
Medigap is supplemental coverage for costs not paid for by Medicare Part A or B. This includes the 20% of Part B but does not include the 5% for Part D plans. It also covers foreign travel, which Medicare does not cover. These plans are state based and managed by private insurers. Available plans are A-N and fluctuate in cost from $50-$500/mo. depending on coverage options.
What is Medicare Advantage, or Part C Medicare, and how much will I pay?
Medicare Advantage plans are managed by private companies and offer inclusive Part A and B coverage. Many add prescription drug coverage (Part D), and some include perks like gym and health behaviors discounts. These will be familiar and are run very similar to private insurance plans. Premiums, copays, and deductibles vary from plan to plan. The average premium in 2022 was $18/mo. The average out-of-pocket cost for Medicare Advantage subscribers was $4,972.
Should I choose original Medicare or Medicare Advantage?
This depends. Medicare Advantage can have lower out-of-pocket costs, but their networks are limited and may not include all the providers you need. It’s also more difficult to change to other plans once an Advantage plan is selected; certain penalties may apply, and you will lose guaranteed issue for Medigap plans should you wish to return to Original Medicare. You have to assess your healthcare needs, the access to providers in the Advantage network, and the savings you may (or may not) have with an Advantage plan.
What can BioMatrix do to help with Medicare?
BioMatrix can check your Medicare benefits and let you know what your anticipated costs will be based on your plan choices. From there we can provide additional information based upon your needs.
Where can I learn more about my Medicare benefits?
You can call Social Security at 800-772-1213 or access the handbook here.
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