The first thing most seniors ask when they visit the doctor is, “Is it covered by Medicare?” Medicare has established deductibles, co-pays, and coinsurance costs. (see the Medicare.gov chart at 2015 Costs at a Glance)
Most Medicare Part D drug plans have out of pocket expenses, monthly premiums, co-insurance and co-payment costs for different kinds of drugs, and you pay a percentage of the drug’s price. Experimental drugs typically are not covered by Medicare.
Copays differ as much as $100 or more for a 30-day supply, even for the same drug. (Hint: when trying a drug with possible severe side effects, only purchase a small supply and test whether it agrees with you. No sense buying more than you will use.)
Part A & B Costs
Medicare Part A and Part B will generally pay 80% of hospital and doctor expenses. Most people pay only $104.90 a month for their Part B premium. The remaining 20% is out of pocket expense that you are responsible for, and why a supplemental insurance plan is recommended.
When visiting your doctor, there is one time annual deductible amount of $147 subtracted from the doctor’s fee after which Medicare typically pays 80% of the Medicare-approved amount of the service.
How to cover the 20% gap
Original Medicare will generally pay 80% of hospital and doctor expenses. You may be responsible for paying the remaining 20% of your Medicare related bills, known as the Gap in your coverage, and there’s no annual limit on what you might need to pay out-of-pocket!
A Medicare Supplement plan (Medigap) generally has a monthly premium with no co-insurance, no co-pays and no deductibles. This is why 9 out of 10 seniors choosing a Medigap plan when they are first eligible and stay with a Medigap plan to help manage their health care costs. See how affordable a supplemental insurance plan can be by contacting a Medicareinc.com licensed professional.