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Understanding Your

Medicare Options
The Parts of Medicare

Part A – Places You Go – Hospitals –Skilled Nursing Facilities, etc.

Part B – People You See & What They Do – Doctors – Nurses – PT

MRI’s - Bloodwork – Diagnostic Tests, etc.

Part D – Prescription Drug Plans – Required for all those enrolled

in Medicare – Penalties apply for late enrollment.
What Medicare Doesn’t Cover
• Your Out of Pocket Expenses
– Monthly Premiums (Parts B & D).
– Annual Deductibles (Parts A, B & sometimes D).
– Co-Insurance (% Paid by you – Parts B & D).
– Co-Payments (Flat fee paid by you – Parts A, B & D).
– Services NOT APPROVED by Medicare.
– Charges above the Medicare Approved amount.
– Dental Care – Vision Care - Eyeglasses
– Hearing Aids – Non-Diabetic Foot Care
– Long Term Care and Ongoing Custodial Home Healthcare
2 Ways to help cover Out of Pocket Costs
– Stay with Original Medicare – Part E
• Purchase a Medigap policy & a Prescription Drug Plan
• Three monthly premiums –
– Medicare Part B Premium – Supplement Premium – Prescription Drug Plan Premium
– Medicare Supplements are also categorized by letter – A through N
– Connecticut carriers offer plans A, C, F, G, K, L and N.
– Supplement plans are standardized plans that offer the same benefits regardless of carrier.
However, prices vary from carrier to carrier.
– With the introduction of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),
Plans C and F will only be available for purchase by those beneficiaries that are eligible for
Medicare Part A before January 1, 2020. This means that if you are enrolled in one of these
plans, you can keep it, or if you wish to enroll in either plan at a later date, you can still do so.
Those eligible for Medicare Part A after January 1, 2020 cannot purchase either of these plans.

– Enroll in a Medicare Advantage Plan with a private carrier – Part C

• Most include a Prescription Drug Plan and are considerably lower in cost.
• Also include additional benefits not available in traditional Medicare or Supplemental policies.
Part A Deductibles and Cost Shares
• Monthly Premium - $0 if you have worked for 40 quarters and paid into Medicare.
• Part A Hospital Deductible - $1484 per benefit period.
– Covers days 1-60 of a Medicare approved hospital stay.
– Days 61 – 90 - $371 per day.
– Days 91-150 - $742 per day.*
• Skilled Nursing Facility after a 3 day in patient stay at a
– Days 1-20 $0 provided you are improving.
– Days 21 – 100 - $185.50 per day.
– After 100 days – 100% of all costs.

• * Days 91-150 are a one time lifetime allotment. Once used not replenished.
Part B Deductibles and Cost Shares
• Monthly Premium - $148.50 for individuals with annual
income below $88,000 and couples with annual income below
• IRMAA – Income Related Medicare Adjusted Amount
applies to those individuals and couples with higher annual
• Deductible - $203 annually on Part B services.
• Co-Insurance – 20% of Medicare Approved amounts for
services and doctors visits after your annual deductible is met.
Part D – Prescription Drug Coverage
• Deductible - $0 to $445 (varies by plan)
• Phase 1 - Deductible Phase - Member pays full cost of most
drugs until deductible is met.* Specialty tier drugs may not be
subject to the deductible.
• Phase 2 - Initial Coverage Phase – $435 to $6550. Plan pays
75% and member pays 25% of cost of medications
• Phase 3 – Coverage Gap (The Donut Hole) - $4130 to $6550.
Plan pays 75% of the medication costs.
• Phase 3 - Catastrophic Phase – Over $6550. Plan pays 95%
and member pays 5% of medications costs
• Co-Pays and Co-Insurance – Tiered by plan design.
Covering the Gaps
• Medicare Supplements – Standardized plans that
cover some or all of the costs not covered by Medicare.
Monthly premiums vary by carrier.
• Medicare Advantage Plans – Private insurance that
provides a network and cost sharing options that cover some
of the costs not covered by Medicare. Network driven and
lower to zero premium options available. Drug plan often
included in the plan.
• PDP Prescription Drug Plans – Drug plans that go along
with a supplement to cover the prescriptions for a beneficiary.
Which plan is right for you?
• Just as the plans vary, so do the needs of each
individual. You need to assess your medical
needs and prescription needs to determine
the best course of action.
• A professional trained to understand the
different plans and plan benefits can help you
decide which plan is best for you and your