Home » Blog » 2019 Medicare Cost Sharing

2019 Medicare Cost Sharing

2019 MEDICARE COST-SHARING

Medicare has released the 2019 Medicare cost-sharing amounts and MOOP for standardized Medicare Supplement Plans. Without further ado, here it is!

Part A: Hospital Insurance

Hospital

  • $1,364 (+$24) deductible per benefit period.
  • $341 (+$6) for days 61-90.
  • $682 (+$12) for 60 lifetime reserve days (days 91-150.)

Skilled Nursing

  • $170.50/day (+$3) for days 21-100.

Part A premium

  • $437 if you’ve worked less than 30 quarters.
  • $240 if you’ve worked over 30 quarters but less than 40.

Part B: Medical Insurance

  • $135.50 premium. Deductible remains at $185.
  • Cost-sharing remains the same for Part B services, Medicare pays 80% and the beneficiary pays 20%.

Part D: Prescriptions

Deductible: $415

  • The standard part D deductible for 201 is $415.  Many plans however have eliminated the deductible entirely.

Initial coverage limit: $0 – $3,820

  • After the deductible has been met, beneficiaries enter into stage 2, the Initial Coverage Limit.  At which point beneficiaries will either pay 25% or more typically they will have co-pays for tiers 1 – 5.
  • Once the retail amount (what you pay + what the carrier pays) of your prescriptions reaches $3,820 for the year, beneficiaries will enter into gap also known as the “doughnut hole.”

Coverage Gap/Doughnut hole: $3,820 – $5,100

  • Once in stage 3, more commonly referred to as the “Gap” or the “Doughnut-Hole” beneficiaries will be paying 25% for brand name drugs and 37% for generics.
  • After out-of-pocket (what you and the manufacturer pay) costs reach $5,100 beneficiaries will enter into stage 4 or “Catastrophic Coverage.”

Catastrophic Coverage

Medicare cost-sharing
  • Once in stage 4, beneficiaries will pay the greater of:
    • 5% OR
    • $3.40 copay for generics and $8.50 copay for all other drugs.

Prescription drug coverage premiums range from $12.70 and up.

Part C – Medicare Advantage plans

Premiums for Medicare Advantage plans range from $0 and up.

Max-out-of-Pocket: $6,700

Cost sharing for Medicare Supplement plans

  • Deductible for the High Deductible plan F is $2,300
  • MOOP
    • Plan K: $5,560
    • Plan L: $2,780