Medicare Can Be Complicated
We're Here To Break It Down
The A, B, C, & D's of Medicare
medicare facts sheet
Part A
Facility-Based Care
Part B
Physician Based Care
Part C
Advantage Plans
Part D
Prescription Drug Coverage
2025 MEDICARE UPDATES
Hospital
(Per Admittance)
| Length of The Stay | Cost of The Stay |
|---|---|
|
Days 1 – 60 |
$1,676 Deductible |
|
Days 60 – 90 |
$419 Co-Pay /Per Day |
|
Days 91 – 150 |
$838 Co-Pay /Per Day |
|
After 150 Days |
Patients Pays 100% of the Stay No Coverage |
| Per Calendar Year (this applies to both Part A & B) |
|---|
|
3 Pints of Blood Deductible |
Skilled nursing
(100 day benefit)
| Length of The Stay | Cost of The Stay |
|---|---|
|
1 – 20 Days |
$0 |
|
21 – 100 Days |
$209.50 /Day |
|
After 100 Days |
Patients Pays 100% of the Stay No Coverage |
| Must be hospitalized for 3 days (72 hours) prior to admittance - *Health Must Improve daily |
|---|
There is no maximum out of pocket cost containment with Medicare Part A on facility expenses
hospice
| Requirements | Cost |
|---|---|
|
Diagnosed Terminal |
Maximum 5% Facility Cost |
Psychiatric hospital
| services | length of services |
|---|---|
|
Confinement |
190 Days in Lifetime |
Home Health
| services | cost |
|---|---|
|
Visiting Nurses & Therapist |
$0 |
Physician Visits
Home Health Care
Outpatient Care Plans
Durable Medical Equipment
Ambulance Services
Preventative Care
What It Costs
-
Based Monthly Premium $185.00/month
Premiums vary based in indexed earnings
-
Annual Deductible $257.00
Single Cumulative charge for all covered services
-
Medicare Pays 80% of Approve Charges
No stop-loss of yearly out-of-pocket maximum
-
You Pay 20% of Approve Charges
No stop-loss of yearly out-of-pocket maximum
Part B is deemed optional due to premium requirements
The Federal Government contracts with private insurance companies to provide Medicare services. These companies are required to offer all Medicare-approved services, although the delivery and structure of those services may vary. Most Medicare Advantage Plans also include additional benefits not offered by traditional Medicare, such as:
Most Advantage Plans
This includes prescription drug coverage (Part D), which usually will save you money on your drug expenses due to combined coverage for medical and drug costs.
All Advantage Plans
These are required to contain maximum out-of-pocket expenses. Advantage Plans utilize networks for these cost savings.
Hearing
Vision
Dental
There is no maximum out of pocket cost containment with Medicare Part A on facility expenses.
Most Advantage Plan
This includes prescription drug coverage (Part D), which usually will save you money on your drug expenses due to combined coverage for medical and drug costs.
All Advantage Plan
These are required to contain maximum out-of-pocket expenses. Advantage Plans utilize networks for these cost savings.
TYPES OF ADVANTAGE PLANS
HMO
Health Maintenance Organization can possibly save you the most money on basic medical services.
PPO
Preferred Provider Organization are typically more expensive than the HMO plans due to providing some additional non-network coverage and freedoms.
Advantage Plans Are Guaranteed Issue Provided You Have Both Medicare Part A and B
Phase 1
You Pay 100% of your Prescriptions
Until out-of-pocket Total reaches: $480
Phase 2
You Pay 25% of your Prescriptions
Until total drug cost reaches: $4,430
Phase 3
You Pay 25% Retail Cost for Name Brands & 25% for Generic Drugs
Until total drug cost reaches: $7,050
Phase 4
You pay $9.85 for Name Brand, $3.95 for Generic, 5% for Specialty Drugs.
Until the end of year
New Year
Plan Starts Over the Following Year
Why Settle For Basic Benefits?
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