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The ABCs of Medicare Coverage
Medicare is the largest health insurer in the country, covering nearly 51 million Americans. It’s a huge program with lots of moving parts. And the four most important parts follow the alphabet: A, B, C, and D. Here’s what you need to know.
If you paid Medicare payroll taxes while working, you’re in luck—no premium for you! Otherwise, you may have to pay up to $426 a month. You also have deductibles, copayments and coinsurance, which vary depending on the service. There is no cap on your annual out-of-pocket costs.
The Part B premium for 2014 is $104.90, although it might be higher depending on your income. There is also a $147 deductible, and you must pay 20 percent of other services. And no cap is provided for annual out-of-pocket expenses. However, all preventive services are free, even if you haven’t yet met your deductible.
The details and cost: You pay the Part B premium and, in some instance, an additional premium to the managed care plan. Unlike Parts A and B, Medicare Advantage out-of-pocket costs are capped each year.
Most Medicare Part D drug plans have a coverage gap, called the “donut hole.” Once you and Medicare spend a certain amount on drugs ($2,850 in 2014), you are “in the hole” and pay 47.5 percent of the cost of brand-name drugs and 72 percent of the cost of generic drugs. Once you spend $4,550 out of pocket, you climb out of the gap, and Medicare covers most of your costs for the rest of the year. (Some prescription drug plans and Medicare Advantage plans cover the gap for you.) The good news? This gap is shrinking and will be phased out completely in 2020, thanks to the Affordable Care Act.
Your Rite Aid Pharmacist can answer any questions you may have about Medicare prescription coverage.
“Medicare & you: What’s Important in 2015,” U.S. Department of Health and Human Services. www.medicare.gov/medicare-and-you/medicare-and-you.html.
“Who relies on Medicare? Profile of the Medicare population,” AARP Public Policy Institute. www.aarp.org/health/medicare-insurance/info-06-2012/who-relies-on-medicare-profile-of-the-medicare-population-AARP-ppi-health.html.