Benefits Overview 2023

Key Medicare Parts A & B Coverage Gaps

Benefit	2023	2022	2021	2020	2019
Part A Inpatient Hospital Deductible	$1,600	$1,556	$1,484	$1,408	$1,364
Hospital Daily Coinsurance 61-90 days	$400	$389	$371	$352	$341
Hospital Daily Coinsurance 91-150 days (lifetime reserve)	$800	$778	$742	$704	$682
Skilled Nursing Facility Care Coinsurance Days 21-100	$200	194.50	$185.50	$176	$170.50
Part B Physician's Services and Supplies Deductibles	$226	$233	$203	$198	$185

Medicare Supplements

Plan F’s benefits cover all deductibles and coinsurances above.

Plan G is the same as Plan F except its does not pay the Part B Deductible (see table above).

Plan N is similar to Plan G – has copays for doctor visits ($20) and ER visits ($50) – additional costs if non-participating providers are used.

The deductible for High Deductible Plans F & G is $2700 (2022: $2490, 2021: $2370, 2020: $2340) (not to be confused with standard Plan F & G)

Part D – Overview

Prescription max limits
- Max Deductible: $505 (2022: $480, 2021: $445, 2020: $435, 2019:$415)
- Initial Coverage Limit: $4460 (2022: $4430, 2021: $4130, 2020: $4020, 2019:$3820) – copays apply
  - Entire retail costs of drugs go toward the Initial Coverage Limit, not just the copays.
Coverage Gap “Donut Hole” (after Initial Coverage Limit has been met)
- Brand Name drugs will have a ~75% discount. (~95% of drugs’ total costs count toward your OOP.)
- Generic drugs will receive a ~75% discount. (The ~25% that you spend counts toward your OOP.)
- https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap
Out-of-Pocket Threshold (The point at which you exit the donut hole): $7400 (2022: $7050, 2021: $6550, 2020: $6350, 2019: $5100)
Catastrophic Drug benefits (after the donut hole)
- Generic/Preferred Multi-Source Drugs – $4.15 for those with retail price under $83. 5% for those with retail price over $83.
- Brand Name Drugs – $10.35 for those with retail price under $207. 5% for those with retail price over $207.
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 $7,400 TrOOP required to reach catastrophic coverage, is reduced by 70-75% 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 $505 depending on plan, amount you pay added to TrOOP.

Phase 2: Initial Coverage
You pay copays until you and insurance have paid $4,660 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 ~75% of the drugs’ costs are credited to TrOOP.

You exit the Coverage Gap when your TrOOP equals $7400 via monies you’ve paid this calendar year and the special ~75% brand name donut hole drug credits mentioned above.

Phase 4: Catastrophic Coverage (After Donut Hole)

Generic/Preferred Multi-Source Drugs – $4.15 for those with retail price under $83. Otherwise, 5% for those with retail price over $83.
Brand Name Drugs – $10.35 for those with retail price under $207. Otherwise, 5% for those with retail price over $207.
NO LIMIT