Of all the Medicare plans, the Part D Prescription (PDP) plans are the most confusing. The confusion arises because Medicare allows the Part D plans to offer alternate plans that differ from the standard plan. The alternate plans must be as good as the standard plan for the average Medicare beneficiary. Cost Sharing of the […]
Post related to Medicare health insurance, Part A, Part B, Part C, and Part D prescription Drug Plans, Medicare Advantage and Medicare Supplement plans.
Medicare Advantage plans, that cannot be paired with a Medicare Supplement plan, is another way to divert much of the storm of health care costs to the gutters and downspouts. The Medicare Advantage plans usually have the Part D drug plan embedded within the total package. There will still be some leaks from copayments and coinsurance with the Medicare Advantage plans.
The higher asset limit applies to non-exempt assets. Generally, assets exempt from the calculation are an individual’s house as a primary residence, one car, burial plot, up to $1,500 in a burial expense account, furniture, and other household and personal items. What has stymied many people from being eligible for some Non-MAGI Medi-Cal programs are the non-exempt assets such as savings accounts, stocks, bonds, or other assets that could be liquidated to pay for health care services.
There are a couple different ways to structure Medicare coverage. In the absence of any extra help from Medicaid or Social Security for Part D prescription drug coverage, the average Medicare beneficiary will realize the $170.10 for Part B and approximately $35 (national average) for a Part D plan. If the beneficiary adds a Medicare Supplement to cover most of the deductibles, copayments, and coinsurance of Original Medicare, there could be an additional cost of approximately $150 (Plan G in California.) That brings the monthly insurance costs up to $355.
In California there are 32 different Part D plans offered by 11 different insurance companies. One plan sponsor offers six different plans. The only thing that differentiates these plans at first glance are the marketing names like Basic, Choice, Classic, Enhanced, Plus, Saver, Secure, and Value. These monikers are marketing gimmicks and tell the Medicare beneficiary nothing about the benefits of the plan.
Premiums, deductibles, and coinsurance for Original Medicare, 2021. Individuals with Medicare Advantage and Medicare Supplement plans may not realizes some of the higher Medicare costs.
You cannot be enrolled in Medicare and a subsidized Covered California health plan. If you are eligible for Part A of Original Medicare, you are ineligible for the federal and state health insurance premium subsidies. If you don’t terminate your Covered California subsidized plan when your Medicare becomes active, you may have to repay all the subsidy amount you received for those months when Medicare became effective.
Medicare Advantage plans more closely resemble a traditional health insurance plan you may have had from your employer or individual and family plan. They have predictable copayments for many routine health care services such as office visits, labs, tests, and x-rays. Most Medicare Advantage plans include the Part D prescription drug coverage within the plan. For medical services, Medicare Advantage plans have a maximum out-of-pocket amount. Once the dollar amount is met, the Medicare Advantage plan covers all future medical services at zero cost to the plan member.
All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
The great thing about Medicare is that you can build your train the way you want. You can change the train cars every year. But the important aspect is that you own the Medicare engine. You are the engineer and you can build your train the way you want it.