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Part 3 Medicare

2018 Medicare Advantage (Part C) costs

The Medicare Advantage program, also known as Medicare Part C, provides a way to receive your Original Medicare (Part A and Part B) benefits, except for hospice care, which Part A covers. Medicare Advantage plans are offered by private health insurance companies approved by the Medicare program, and sometimes include additional benefits such as routine vision care. While these insurance companies must follow government regulations, they have some flexibility in setting certain costs and/or additional coverage rules, as well as what additional benefits they may provide with their coverage. This means that the availability, benefits, costs, and other details of these plans can change from year to year.

In regards to 2018 costs, your out-of-pocket expenses depend on the Medicare Advantage plan you’re enrolled in.

2018 Medicare Part D costs

Medicare Part D Prescription Drug Plans are similar to Medicare Advantage plans in that these plans are also offered by Medicare-approved private insurance companies. Medicare Part D prescription drug plan availability, costs, benefits, and other details also vary by plan and may change each year.

While insurance companies set most of their Medicare Part D costs, there are certain predetermined limits set by the government on an annual basis. In 2018, no Part D Prescription Drug Plan can have an annual deductible higher than $405.

There are also limits related to the Medicare coverage gap, also known as the “donut hole.” Not everyone will reach this gap. Beneficiaries will hit this Medicare Part D coverage gap in 2018 when they and their plan have spent a total of $3,750 on covered prescription drugs, which includes the annual deductible (if your plan has one). Once beneficiaries have entered the coverage gap in 2018, they will generally pay no more than 35% of their plan’s cost for brand-name drugs and 44% of their plan’s cost for generic drugs. Beneficiaries will exit the coverage gap and enter the catastrophic coverage phase when they reach a total of $5,000 on eligible prescription drug costs for the year. After you have reached the catastrophic period, you’ll pay a small copayment or coinsurance amount for covered prescription drugs.

There are many Medicare plan options in 2018, and I can tell you more about the plans eHealth offers.

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When people talk about Medicare costs, you may hear the phrase “out-of-pocket” used frequently. But what does it mean? “Out-of-pocket” medical expenses refer to any health-care expenses you have to pay yourself. With Medicare, these expenses may include copayments, premiums, deductibles, and coinsurance amounts.

Your out-of-pocket Medicare costs may depend on the type of Medicare coverage you have, the specific health-care services you use, and how often you need them. While many Medicare plans may offer similar types of coverage, the amount you have to pay can vary among various types of Medicare insurance, and among individual plans.

When considering potential out-of-pocket medical expenses, here’s an overview of things to keep in mind.

What does “out-of-pocket” mean?

As mentioned, the term “out-of-pocket” refers to the expenses that you must pay yourself, including both costs for Medicare-covered services and services that Medicare doesn’t cover. It’s also important to note that Original Medicare doesn’t have an out-of-pocket maximum amount.

Whether you’re covered through Original Medicare or a Medicare Advantage plan, Medicare doesn’t pay for all of your health-care expenses; you’re still responsible for certain costs that Medicare doesn’t cover. This may include:

  • Monthly premiums
  • Copayments and/or coinsurance
  • Deductibles
  • Limiting charge (no more than 15% above the Medicare-approved amount for the service) if you use a provider that doesn’t accept Medicare assignment, meaning the provider doesn’t accept the cost set by the Medicare program as full payment for the service.
  • Pharmacy dispensing fee (if you’re enrolled in a Medicare Prescription Drug Plan)
  • Any of the above costs may be expenses you must pay “out of pocket,” after Medicare has paid its share for covered services.

In addition, you’re also responsible for paying for services that Medicare doesn’t cover, such as long-term nursing care, acupuncture, cosmetic surgery, or health-care services when you’re outside of the country in most situations. If Medicare doesn’t cover a certain service or item, you may need to pay the entire cost, unless you have other coverage.

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