Jason Friedman Discusses Medicare, MediGap, Medicare Advantage and Part-D Options

We were so glad to welcome Kathy Huber to our meeting, wife of former Club member Phil who has been truly missed.

Jason Friedman with Young's Insurance Service spoke to us about Medicare … knowing its "A, B, C … and D":

Part A – covering Hospital costs

  • Free for most people
  • There is a $1,408.00 Hospital deductible per benefit period (60 days)
  • Hospital co-pay is $352.00/day after 60-days
  • Skilled Nursing Facilities co-payment is $176.00/day for 21-100 days

Part B – Medical insurance coverage (doctors, etc;)

  • Cost $144,60/month per person
  • Covers 80% – patient pays 20% co-insurance (no annual limit) after a $198.00 annual deductible

Two ways to use Medicare Benefits

Option #1

  • MediGap Supplement policy – offered by private companies to pay most of all A&B co-insurance and deductibles
  • Part-D – a government program to offer prescription drug coverage from private companies
  • Pro:

    • Can go to any provider nationwide that accepts Medicare, no referrals
    • Plans are standardized (F, G, N, etc;)
    • Medicare copays and deductible can be eliminated and coverage remains the same for life
  • Con:
  • Premiums increase as one ages
  • Must buy Stand-alone Part-D Prescription Drug Plan
  • May be difficult to switch to another MediGap, as they are subject to medical underwriting after MediGap Open Enrollment Period ends

Option #2

Medicate Advantage Plan

  • Part-C

    • Offered by private companies
    • Subsidized by Medicare
    • Patient must continue to pay their Part B premium
    • Can come with or without Part- Prescription Drug coverage
    • Pro:
  • Premiums are lower than MediGap and include Part-D Prescription Drug coverage
  • Able to pick up any Advantage plan during the Annual Election Period
  • Plans may include extras (Gym – OTC purchases – Dental – Vision – Hearing)
  • Con:
  • Copays for most services and out-of-pocket max up to $6,700.00 per year
  • Copays, premiums and networks can change annually
  • Network-based plans (HMO or PPO)
  • HMOs can require referrals and capitation; only covered out-of-network for emergencies

Part-D – Prescription Drug coverage

  • Run by private insurance companies
  • Formularies and copays vary from plan to plan
  • Stand-alone or with a Medicare Advantage plan
  • Patient pays a portion of the drug cost

Most basic or model 2020 Medicare Part D plan is broken down into four main parts:

  • Part 1 – The initial $435 deductible – Some plans do not have an initial deductible and provide "first dollar coverage"
  • Part 2 – Coverage – The plan provides the Medicare Part D patient with co-insurance or medication co-payment. Usually, coverage extends to a point where the total retail cost of the medication reaches $4,020 – however, some plans lower this limit to $2,000 or even $1,850 (lower limits are used to lower monthly premiums for people with minimal medication needs)
  • Part 3- The Coverage Gap or Donut Hole – The patient pays 100% of their Medication costs – Some plans do provide partial or complete coverage for this gap in the Medicare Part D coverage.
  • Part 4 – Catastrophic Coverage – When a person has spent more than $6,350 for prescription medications, they will be protected by Catastrophic

The Club wants to thank Jason for his extremely informative presentation.