Benefits Overview 2019

//Benefits Overview 2019
Benefits Overview 20192018-10-15T10:02:20+00:00

Key Medicare Parts A & B Coverage Gaps

Benefit2016201720182019
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$167.50170.50
Part B Physician's Services and Supplies Deductibles
$166$183$183 (same)185.50
Occupational Therapy (OT) services$1,960$1,980$1,980 (same)Unlimited

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 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

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