Medicare supplement insurance solutions found here….
Welcome to the MidAmerica Life & Health website, where you can find a solution to your financial risks associated with the gaps in Medicare insurance.
Now that you are eligible for Medicare, think everything is taken care of? Think again… Medicare was never meant to cover all your medical expenses. For that reason there are gaps in coverage due to the requirement for cost sharing.
What are these “gaps”?
The cost-sharing gaps you are expected to fill are deductibles, co-insurance, and co-pays of the federal insurance plan. Deductibles and co-pays are usually expressed in flat dollar amounts and co-insurance in percentage. Premiums are not considered gaps. Your premium for Part A is usually $0 but the Part B premium is determined annually and published by Medicare in late October for the upcoming new year.
For 2018, through December 31st, the following cost sharing applies:
For Part A cost sharing, your hospital insurance coverage:
- A hospital admittance as an inpatient is required. (Observations are not covered under Part A, but under Part B) :
- A deductible starting day 1 of $1,340 . This applies per benefit period (No re-admission within 60 days).
- And for extended stays, a co-insurance amount of $335/day beginning on the 61st day up through the 90th day.
- (Longer stays have more restrictions and co-insurance)
- If you require rehab in a Skilled Nursing Facility (SNF), after a 3 day minimum stay in the hospital, your first 20 days co-pay is $0. Beginning day 21, the co-pay is $164.50/day up through day 100. You pay for all costs beyond the 100th day.
For Part B (medical expenses) coverage cost sharing :
- A monthly premium of $130*, (subject to an income related monthly adjusted amount (IRMAA)**, in addition to an annual deductible of $183 /year. Once you satisfy the deductible, then there is a 20% co-insurance on all remaining medical expenses.
- * (For those already enrolled in 2017 and getting Social Security benefits – the “Hold Harmless” group).
- ** Those new to Medicare in 2018 or paying direct will have a base premium of $134, subject to IRMAA.
Part C plans are optional, and replace the Part A and B gaps above with their own gaps:
- Part C plans are known as Medicare Advantage plans. Many people call them co-pay plans because they are the commonly known managed care plans (HMOs, PPOs, etc). The premiums, deductibles and co-pays vary widely because they are administered by private insurance companies under contract with Medicare. The reason their gaps are not expressed the same as Original Medicare is because they are allowed to actuarially adjust those amounts as long as the overall benefits are deemed by Medicare to be as good or better than Original Medicare.
Part D- Prescription Drug Plans (PDP) cost sharing:
- Part D (drug) coverage plans are modeled after a Medicare design in order to offer prescription medication for Medicare beneficiaries. They lighten the costs of medicine, and for low income beneficiaries, significantly. These plans are also administered by private insurance companies under contract with Medicare. The monthly premiums vary among carriers but average about $35.02/mo, depending on the plan benefit level and company chosen. In addition, there may be a deductible before the plan begins to pay benefits of $0-$400. A drug list is formulated and co-pays are established for various drugs.
Please note: The Prescription drug gap, a.k.a “donut hole”, has no solution from the public end. It is being gradually closed by Medicare on an annual basis so that it will be gone by 2020. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2018, once you and your plan have spent $3,750 on covered drugs, you’re in the coverage gap/donut hole.
What is the biggest financial exposure in all these gaps?
Most people will say it is the 20% Part B co-insurance…. Think of a big surgery bill…. Then do the math. (Example: a $50,000 surgery bill at 20% will leave you $10,000 out of pocket for you to cover… and that’s not even a really big surgery bill!)
How do I fill in these gaps?
If you have Original Medicare (Part A and Part B):
- buy a Medicare Supplement Insurance Policy (Medigap). These plans are standardized and labeled with letters of the alphabet (A thru N) along with a Part D, Prescription Drug Plan (PDP) – Medigaps offer no drug coverage, so you will have two policies to maintain.
- enroll in a Medicare Advantage plan with an included drug plan. A Medicare Advantage Prescription Drug Plan (MA-PD) replaces Original Medicare and substitutes cost sharing that varies among MA carriers. Essentially it breaks down the big Part A deductible for short stays and has low or no premiums. The down side is that with long hospital stays, the co-pay total may run more than Original Medicare. The upside is that they often include a Part D drug plan.
Alert!! If you choose a Part C (Medicare Advantage or Co-pay) plan:
Because hospital co-pays can mount up with stays longer than a few days— consider a hospital indemnity plan to cover that contingency.
Medicare supplement insurance solutions found here….
MidAmerica Life & Health
– is proud to offer Medicare supplement insurance plans for residents of KS, MO, IA, NE, and AR from among the following companies*:
*not all plans are available in all states and benefits, features, and rates may vary by state
(Aetna, Inc – including Aetna Life Insurance Company, Aetna Health Insurance Company, and Coventry Healthcare of Kansas)
United Healthcare Medicare Solutions (United HealthCare Services, Inc.)