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The different parts of Medicare help cover specific services:


Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.


Medicare Part B (Medical Insurance) 

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.


Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.


Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

The Four Stages of Drug Coverage

What you pay for your covered drugs depends, in part, on which coverage stage you are in.


You will get an Explanation of Benefits (EOB) each month you fill a prescription. It will show which coverage stage you're in and how close you are to entering the next one.

 
 
 
Stage 1
Stage 2 
Stage 3 
Stage 4 
Deductible 
 Initial Coverage
 Coverage Gap
 Catastrophic Coverage
 If you have a deductible, you will pay 100% of your drug cost until your deductible is met. (If you have no deductible, or if a specific drug tier does not apply to the deductible, you will skip to Stage 2.)
You will pay a copay or coinsurance, and your plan pays the rest for your covered drugs.
In this stage, you pay a greater share of your drug costs. It begins after you and your plan have paid $3,750 on covered drugs during Stages 1 and 2. After you enter the coverage gap, you pay 35% of the plan's cost for covered brand-name drugs and 44% of the plan's cost for covered generic drugs until your costs total $5,000, which is the end of the coverage gap. Not everyone will enter the coverage gap. Some plans have additional coverage during the gap. 
In this stage, after your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,000. you pay the greate of:
  • 5% of the cost,
or
  • $3.35 copay for generic (including brand drugs treated as generic) and a $8.35 copay for all other drugs.
Have questions about Medicare? Ask me about your Medicare options by calling 888-357-1999 or by sending a message request below to Medicare Options Info, Inc. A licensed independent insurance agent appointed with multiple carriers will help you make an informed decision. Agent is not connected in any way with the federal or state government or Medicare.
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