Michael M Insurance Services Blog
Good News! Most plans are including a Free Gym Membership with their Plans! So, why are they being so generous? Well, they've figured out that if you stay healthy their costs go down so, you might as well take advantage of it.
Here are some Highlights-
17000 Locations Nationwide
Live Classes and Workshops
"Get Active, Feel Great!"
I'm inclined to agree.
Go For It!
Medicare does not cover Medications unless they are administered in a Doctors office or facility, in which case they will be covered under Medicare Part B. In order to get your Meds you will need to obtain coverage from a private company. They have monthly premiums, the national average is somewhere around $30.00. If your income is above a certain level you could pay more and if you don't get one when you are first eligible you will get a penalty.
Medications are classified in Tier Levels. Examples are-
Non Preferred Brand
As you can imagine, the Copay will increase as you move from Preferred Generic to Specialty and the costs will vary between companies so it is very important to compare using your particular list of Medications.
Most Plans have a Deductible and as a rule the Deductible only applies to the higher Tier Drugs and generally not to the Generics. If you are on one of the Brands or a Specialty you will pay the Plan Deductible before the plan begins to Pay.
Simply, a Copay is a fixed amount and Coinsurance is a percentage of the cost.
Coverage Gap- "The Donut Hole"
This occurs when the beneficiary(You) and the insurance company spend up to a predetermined level. At that point, your cost share will increase, you are in the Gap or Donut Hole. When you reach another level of spending your cost share will dramatically decrease. When this happens is determined by how expensive your Medications are and people that are on Generics never get there.
The 4 Stages of Coverage-
Deductible- The amount you will have to pay before your plan begins to pay. Generally this does not apply to Generics.
Initial Coverage- Deductible complete, the plan is covering your Meds and your cost share is copays and/or coinsurance if applicable.
The Gap- You and the Insurance Company have reached a predetermined level of spend and your costs have gone up.
Catastrophic Stage- You and the Company have reached the next predetermined level of spend and your costs have come way down.
There are programs available to Seniors that help with the costs of expensive Medications.
Extra Help- Is a Federal Program designed to help lower the cost of medications and help pay plan premiums.
State Help- Some States have their own programs such as EPIC which is a New York State plan. Check with your State for availability.
All programs are income based and if low enough some may qualify for their State Medicaid plan.
Medicare Part A Hospital -
Most people have worked long enough and paid into the system to get their Part A Hospital coverage for Free. Others that come into the workforce late will have a premium. But, how much will they pay? That depends upon how long they paid in for. The Government benchmark is 40 quarters (10 Years) of taxable employment for Free Hospital A. For 2022 anything less will be as follows:
If you worked for-
30-39 Quarters- Your Part A Premium will be $274.00
29 Quarters or less- $499.00
Never worked- You can buy Part A for $499.00 per month.
Part A coverage is divided up into benefit periods that last 60 days. The breakdowns are as follows:
Days 1 - 60 Your responsibility will be a Copay in 2022 of $1556.
This is a flat amount that will be paid whether you are in for 1 day, 60 days or anywhere in between. Using the Government reasoning, stay as long as you can, you'll get more bang for the buck.
Days 61 - 90- $389.00 Per Day
Well, that's no fun. The good news is you probably won't be there that long. Most of the time you will be moved to a Skilled nursing facility.
Days 91 - 150- $778.00 Per Day
Not getting any better.
The good news is most Hospital stays are 1-3 days so the first scenario is the most common. The clock resets every 60 days so if you have to return for for something within 60 days of your stay you will not have to pay. If it is another issue you will. As a matter of fact, if there are multiple issues there will be multiple copays with No Cap on what you can spend which facilitates the need for Insurance to go with your Medicare.