|Part A Inpatient Hospital Deductible||$1,288||$1,316||$1,340||$1,364
|Hospital Daily Coinsurance 61-90 days||$322||$329||$335||$341
|Hospital Daily Coinsurance 91-150 days (lifetime reserve)||$644||$658||$670||$682
|Skilled Nursing Facility Care Coinsurance Days 21-100||$161||$164.50||$167.50||170.50
|Part B Physician's Services and Supplies Deductibles|
|Occupational Therapy (OT) services||$1,960||$1,980||$1,980 (same)||Unlimited
Plan F’s benefits cover all deductibles and coinsurances above. Plan G is the same except its does not pay the Part B Deductible, $185.50 in 2019. However, Plan G’s premium savings make it a better buy over F for 2019. Furthermore, Plan F will not longer be sold after 2019.
High Deductible Plan F (not to be confused with standard Plan F) deductible for 2019 is $2240 (2018 was same)
Part D – updated for 2019
- Prescription max limits
- Max Deductible: $415 (2018:$405)
- Initial Coverage Limit: $3820 (2018:$3750) – copays apply
- During Donut Hole (after Initial Coverage Limit has been met)
- Out-of-Pocket Threshold (The point at which you exit the donut hole): $5100 (2018:$5000)
- Catastrophic Drug benefits (after the donut hole)
- Generic/Preferred Multi-Source Drug – Higher of $3.35 or 5%
- Other Drugs – Higher of $8.35 or 5%
- See our Part D Page for information on purchase and annual review.
- “Medicare and You” 2018: https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf
Medicare home page https://www.medicare.gov/
Part D – A Simplified Explanation
Below is Dee-Signed’s simplified explanation of Medicare Part D Benefits 2019 (Not a legal interpretation)
First, a definition
True Out-of-Pocket (TrOOP) is a term used to refer to all the monies you have spent (as well as some bonus credits from name brand drugs taken in the Coverage Gap “donut hole”) towards the $5100 limit where you leave the Coverage Gap “donut hole” and enter Catastrophic Coverage.
In a nutshell: Your portion of the $5,100 TrOOP required to reach catastrophic coverage, is reduced by 50% of the cost of brand-name drugs purchased while in the “Donut Hole”.
Annually, there are four “phases” of Medicare Part D, each handles prescription costs differently.
Phase 1: Deductible
You pay $0 to $415 depending on plan, amount you pay added to TrOOP.
Phase 2: Initial Coverage
You pay copays until you and insurance have paid $3,820 for the year. Your copays are added to TrOOP.
Phase 3: Coverage Gap (Donut Hole)
Generic Drugs: You pay 37% – that amount is added to TrOOP
Name Brand Drugs: You pay 25% – that amount is added to TrOOP. ADDITIONALLY 50% of the drugs’ costs are credited to TrOOP.
You exit the Coverage Gap when your TrOOP equals $5100 via monies you’ve paid this calendar year and the special 50% brand name donut hole drug credits mentioned above.
Phase 4: Catastrophic Coverage (After Donut Hole)
You pay the higher of 5% or $8.35 brand/ $3.35 generic. NO LIMIT