Key Medicare Parts A & B Coverage Gaps

Benefit20202019
Part A Inpatient Hospital Deductible$1,408$1,364
Hospital Daily Coinsurance 61-90 days$352$341
Hospital Daily Coinsurance 91-150 days (lifetime reserve)$704$682
Skilled Nursing Facility Care Coinsurance Days 21-100$176$170.50
Part B Physician's Services and Supplies Deductibles
$198$185

Medicare Supplements

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 2020. Furthermore, Plan F will not longer be available for those first eligible for Medicare after 2019.

High Deductible Plans F & G deductibles for 2020 are $2340 (2019:$2300) (not to be confused with standard Plan F & G)

Part D – updated for 2020

  • Prescription max limits
    • Max Deductible: $435 (2019:$415)
    • Initial Coverage Limit: $4020 (2019:$3820) – copays apply
  • Coverage Gap “Donut Hole” (after Initial Coverage Limit has been met)
  • Out-of-Pocket Threshold (The point at which you exit the donut hole): $6350 (2019:$5100)
  • Catastrophic Drug benefits (after the donut hole)
    • Generic/Preferred Multi-Source Drugs – $3.60 for those with retail price under $72. 5% for those with retail price over $72.
    • Brand Name Drugs – $8.95 for those with retail price under $179. 5% for those with retail price over $179.
  • See our Part D Page for information on purchase and annual review.
    http://www.deesigned.com/medicare/medicare-part-d/
  • “Medicare and You”: 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 $6,350 TrOOP required to reach catastrophic coverage, is reduced by 70% 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 $435 depending on plan, amount you pay added to TrOOP.

Phase 2: Initial Coverage
You pay copays until you and insurance have paid $4,020 for the year. Your copays are added to TrOOP.

Phase 3: Coverage Gap (Donut Hole)
Generic Drugs: You pay 25% – that amount is added to TrOOP
Name Brand Drugs: You pay 25% – that amount is added to TrOOP. ADDITIONALLY 70% of the drugs’ costs are credited to TrOOP.

You exit the Coverage Gap when your TrOOP equals $6350 via monies you’ve paid this calendar year and the special 70% brand name donut hole drug credits mentioned above.

Phase 4: Catastrophic Coverage (After Donut Hole)

  • Generic/Preferred Multi-Source Drugs – $3.60 for those with retail price under $72. 5% for those with retail price over $72.
  • Brand Name Drugs – $8.95 for those with retail price under $179. 5% for those with retail price over $179.
  • NO LIMIT