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Medicare

Medicare consists of parts A, B, C, D. Part A covers hospital care, Part B covers medical care, Part C are Medicare Advantage plans from private insurers as an alternative to Parts A and B, and Part D covers prescription drugs. Costs for 2023 include a $164.90 monthly premium for Part B and a $505 deductible for Part D. The "donut hole" refers to a period in Part D where beneficiaries pay 25% of drug costs. Supplemental plans like Medigap can help cover costs not paid by original Medicare. Patients can find cost information and compare plans on websites like Medicare.gov and q1medicare.com.

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83 views14 pages

Medicare

Medicare consists of parts A, B, C, D. Part A covers hospital care, Part B covers medical care, Part C are Medicare Advantage plans from private insurers as an alternative to Parts A and B, and Part D covers prescription drugs. Costs for 2023 include a $164.90 monthly premium for Part B and a $505 deductible for Part D. The "donut hole" refers to a period in Part D where beneficiaries pay 25% of drug costs. Supplemental plans like Medigap can help cover costs not paid by original Medicare. Patients can find cost information and compare plans on websites like Medicare.gov and q1medicare.com.

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Medicare

Hailey M. Stoker, PharmD


December 2022
Presentation Objectives
• Recognize differences between Medicare types (i.e., A, B, C,
D, etc.)

• Know where to find cost for medications

• Know where patients can find costs for medications


Medicare Alphabet: A-D

Part A: Hospital Part B: Medical Part C: Medicare Part D: Drug


Insurance Insurance Advantage Coverage
• Inpatient care, • Physicians, • Medicare- • Prescription
SNF, hospice, outpatient care, approved plan drugs, some
HHC HHC, DME, from private shots/vaccines
• Premium based preventive company
on when signed services • Alternative to
up or paying A+B ("Original
Medicare taxes Medicare")
~10 years
Costs Associated for 2023
• Part B:
• Premium: $164.90 monthly
• Higher income (individual >$97,000 yearly) have higher monthly premiums
based on brackets
• Deductible: $226

• Part D:
• Premiums: $0
• Premiums for those in higher income brackets
• Deductible: $505
• Donut hole
The "Donut Hole"
What do you pay
during that
period?

Deductible:
• 100%
Initial Coverage:
• Variable (Copay)
GAP:
• 25% max
Catastrophic Coverage:
• ~5%
https://boomerbenefits.com/medicare-part-d-plans/medicare-donut-hole-2023/
Medicare Alphabet: Supplement/Medigap
• Part F, G, K, L, M, N: Additional insurance bought from a
private company that pays costs acquired after use of
Original Medicare

https://www.medicareadvantage.com/medicare-supplement/plan-e
Medicare Alphabet: Supplement/Medigap
• What is NOT covered?
• Long-term care
• Vision or dental services
• Hearing aids
• Eyeglasses
• Private-duty nursing

• Plans C and F are no longer available federally to new


members as of 2020
• Plan F is the most common Medigap plan currently
• May still acquire plans if available in your area
Medicare Alphabet: E, H, I, J
• Supplement Insurances
• Not available to new members since 2010
• May keep current plan indefinitely
• Expected that premiums may continue to rise
Medicare Open Enrollment:

• Oct 15 – Dec 7 each year


• "Annual Enrollment Period" or "Annual Election
Period" (AEP)
• May enroll in Medicare Advantage plans, switch
advantage plans, or return to Original Medicare
Open
Medicare Advantage Open Enrollment: Enrollment
• Jan 1 – March 31 Initial Election Period
(IEP): Can enroll in Part C
• Already enrolled in Part C 3 months before 65th
• May switch Advantage plans or return to Original birthday, the month of 65th
Medicare as well as add Part D birthday, and 3 months
after 65th birthday.
What if...
• The patient didn't sign up for Medicare during the IEP?
• May have to pay up to 10% more for every 12 months past IEP (20% for 24 months,
30% for 36 months, etc.)
• The patient (or their spouse) is still working?
• Working >20 hr weekly:
• Can wait until uninsured or stop working to sign up for Part B
• Part A is optional based on premium cost
• Medicare pays first, job-based insurance pays second
• Working <20 hr weekly:
• Can wait until uninsured or stop working to sign up for Part B
• Ask job about signing up for part A/B as they may not pay hospital costs
• Job-based insurance pays first, Medicare pays second
• Other (i.e. self-employed, alternative insurance):
• Call insurance to discuss coverage
Patient Resources
• https://www.medicare.gov/
• Costs of Medicare
• Process for signing up
• Checking benefits
• Reviewing/switching coverage

• https://www.medicareadvantage.com/
• Reviews Medcare advantage plans by state
Q1medicare.com
• Part D vs Advantage Plan
(Select the state)
• Select the county (Only for
Advantage Plan) Plan Name

• Find the patient's plan


• On the right side, click "browse
formulary"
• For more information on what is
covered by the plan, click on the
plan name of the plan
Q1medicare.com cont.
• Formulary
• Tier separated to non-preferred, preferred, specialty, and
generic

• Clicking on the underlined percentage/cost will expand cost


details for an exact value
References
1. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-
medicare

2. https://www.medicareadvantage.com/plans-by-state/indiana

3. https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-
deductibles-2023-medicare-part-d-income-related-monthly

4. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/yearly-
deductible-for-drug-plans

5. https://boomerbenefits.com/medicare-part-d-plans/medicare-donut-hole-2023/

6. https://www.ehealthinsurance.com/medicare/blog/medicare-tips/are-medicare-advantage-
plans-being-phased-out/

7. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65

8. q1medicare.com

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