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Clover 

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BCBS-Anthem


Original Medicare- Likely cost 

Assisting customers in your state: GA-MS-AL-SC-NC-TN-MI-OH-PA-LA-MD-AZ-IL-TX

  • High costs are typically hospitalization costs involved, post care, and for critical diseases. Below are some outlines of such expenses:
  • Part A: covers Hospital Inpatient Stay which has following limitations in each benefit period of 12 months:
  • You pay $1,288 deductible and no coinsurance for days 1 – 60.
  • You pay $322 per day for your hospital stay for days 61 – 90.
  • You pay $608 per day out of your lifetime reserve of 60 days above from 91 – 150 days. Thereafter, you pay flat hospital charges for stay.
  • If you need Skilled Nursing Facility Care, you pay $0 for first 20 days, and $152 per day for days 21 – 100. After 100 days, you pay full charges.
  • If you are back to hospital within 60 days of discharge, your stay days are counted in same benefit period.
  • Part B It helps pay for a variety of medically necessary care such as hospital inpatient and outpatient, clinical, and doctors’ office. This includes services by physician, surgery, nursing, laboratory, diagnostic, medical support equipment, emergency, urgent room services, skilled nursing care, mental health care as outpatient, necessary drugs administered by doctors, and hospital medications etc. Your copayment and coinsurance are as follows:
  • Your deductible is $166. You must pay this basic expense before your coinsurance.
  • Your coinsurance is generally 20%, and may be more on some services; Part B. pays the rest of costs.
  • The amount Part B will pay for any service or procedure is called Medicare approved amount. Most doctors agree to take Medicare approved amount as full payment, termed as ‘accepting assignment’. However, doctors who do not agree to Medicare approved amount are permitted to charge up to 15% additional.
  • There is no limit or cap on your ‘out-of-pocket’ expenses of cost sharing coinsurance. If you are hospitalized and undergo some surgery or procedures; or you have a chronic condition that requires lot of care; or you have a serious illness; your cost sharing can be sudden, substantial, and financially draining.
  • Part D: Depending on the standalone Prescription Drugs Plan, you have purchased from an approved CMS vendor, the prescription drugs is as per its plan. Medicare has issued guidelines for the type of drugs that must be covered by drug plans and the minimum standards of benefits. Insurance companies design different plans, which conform to or exceed minimum standards set by Part D. These plans vary by cost and by their formulary, or list of specific drugs covered. Drug plans have preferred and non-preferred pharmacies to choose from and the geographical area they are offered.

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