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WELCOME 2020!



Some Medicare Advantage Plans cover services that are not covered by Original Medicare. Common supplemental benefits include dental care, vision care, and hearing aids.

In 2019, Medicare Advantage Plans were granted more flexibility in the supplemental benefits. This includes the ability to offer benefits that are not directly considered medical care and this might include in-home supports and home modifications.

For this year, 2020, plans are now allowed to begin offering supplemental benefits that are not primarily health-related for individuals who have chronic illnesses. These benefits might include meal delivery, transportation for non-medical needs, and home air cleaners. 

Fact: Medicare Advantage Plans, sometimes referred to as Part C, contract with the federal government and are paid a fixed amount per person to provide Medicare benefits. Plans must provide all Part A and Part B services offered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care. 


Medigap Changes

As a result of federal legislation, individuals who are newly eligible for Medicare on or after January 1, 2020, will not be able to purchase Medigap Plan C or Plan F (including the Plan F high-deductible option). This is because, after such date, the law prevents individuals new to Medicare from purchasing Medigap that pays for the Part B deductible. This law also applies to the three states - Massachusetts, Minnesota, and Wisconsin, that operate their own Medigap systems. However, If you were eligible for Medicare before January 1, 2020, you will not be affected by these Medigap changes and will still be able to purchase Plan C or Plan F.


Donut Hole Closure

Donut Hole is a phase of Part D coverage during which you pay more for the cost of your prescription drugs. In the past, beneficiaries used to pay a high percentage of the cost of their drugs, but over the years this percentage has been decreasing. The donut hole closes completely in 2020, which means that you pay, on average, 25% of the cost of your generic and brand-name drugs.



Part A Costs: Hospital Insurance

Premium

If you’ve worked 10 years or more                                      Free
If you’ve worked 7.5 to 10 years                                         $252 / month
If you’ve worked less than 7.5 years                                   $458 / month

Deductible

For each benefit period                                                        $1,408

Hospital Coinsurance

First, 60 days of inpatient care each benefit period              $0
For days 61-90 each benefit period                                      $352 / day
After day 90 in a benefit period                                           $682 / day
                                                                                Lifetime reserve day


Skilled Nursing Facility-Coinsurance

First 20 days of inpatient care each benefit period              $0

For days 21 – 100 each benefit period                                 $176/day


A benefit period begins the day you start getting inpatient care. It ends when you haven't received an inpatient hospital or skilled nursing facility care for 60 days in a row.

You have 60 lifetime e days that can only be used once and they are not renewable.



Part B Costs: Medical Insurance

Premium

Standard premium if your annual income is                         $144.60 / month
below $87,000 ($174,000) for couple

People with high incomes have a higher Part B premium.

People with limited incomes may be eligible for the Medicare Savings Program for help paying their Part B premium.

Deductible

The Annual amount of                                                                 $ 198 / year

Coinsurance

For the most part B-covered services                                          20%




Part D Costs: Prescription Drug coverage
Premium

The premium varies by Part D plan                                     $ 32.74 / month

People with higher incomes have higher Part D premiums.

Deductible

The deductible varies by Part D plan                                  Up to $ 435 / year

If you have extra help, you will have a low or no deductible.



Part D Coverage Phases

  • Deductible Period
       If your plan has a deductible, you will have to pay the full costs of your drugs (1005) until you meet the amount.
  • Initial Coverage Period
      It begins after you meet the deductible.
      Brand-name drugs: You pay 25%; get 75% discounted 
      Generic drugs: You pay 25%; get 75% discounted
  • Catastrophic Coverage
      Begins when you have paid $6,350  for your covered drugs (does not include the premium).
      Your plan pays 15% and Medicare pays 80%.


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NCOV -19 and MEDICARE 2020

Medicare Part B , which includes a variety of outpatient services cover medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. It will cover medically necessary imaging tests, such as computed tomography (CT) scans, as needed for treatment purposes for lung infections, however not for screening asymptomatic patients. For those imaging tests paid by Part B, beneficiary coinsurance and deductible would apply. If the Part B deductible ($198 in 2020) applies to the Part B services, beneficiaries must pay all costs - up to the approved amount of Medicare until the beneficiary meets the yearly Part B deductible. Once it is met, Medicare pays its share, and beneficiaries typically pay 20% of the approved amount of the service, except laboratory tests. There’s no yearly limit for what a beneficiary pays out-of-pocket tho
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Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red
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Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit
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