Most Medicare recipients who don’t receive Medical Assistance pay for some or all of the following costs related to Medicare:
For Medicare Part A (Hospital Insurance):
The Medicare Part A inpatient hospital deductible of $1408 covers beneficiaries share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.
- Days 61 – 90: $352 coinsurance per day of each benefit period
- Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
For Medicare Part B (Medical Insurance):
- Premium ($144.60/month) – usually deducted from Social Security Disability check
- Deductible ($198/year)
Co-insurance (20% for most services - Medicare covers other 80%; 50% for some psychiatric services – Medicare covers other 50%)
For Medicare Part D (Prescription Coverage):
- Premium (amount differs according to the plan you choose)
- Standard Initial Deductible (Up to $435 in 2020)
While the Part D coverage gap (“donut hole”) officially closes in 2020, that does not mean beneficiaries don’t have to share a portion of costs after the initial coverage period:
The beneficiary will continue to pay 25% for both generic drugs and brand-name drugs, plus a small portion of the pharmacy dispensing fee (approx. $1-$3).
The plan pays 75% of the cost of generic drugs and 5% for brand-name drugs.
The drug manufacturer provides a 70% discount on brand-name drugs.
If you receive both Medicare and Medical Assistance, you pay almost none of the above costs if your providers accept Medical Assistance. This may save you at least $1,000 per year, or many thousands. The only costs you pay are:
A small co-payment for prescriptions ($1.30 for generic drugs; $3.90 for name brand drugs in 2020), and
The difference between your Part D plan’s monthly premium and $32.74 in 2020. If your Part D plan’s premium is $32.74/month or less in 2020, you pay no premium for Part D.
If your health care providers accept Medicare but NOT Medical Assistance, you will have to pay the Medicare deductibles and co-insurance for their services. You will NOT have to pay the Medicare premiums.
If your health care providers do NOT accept both Medicare and Medical Assistance, you may find other providers who do – then you will not have to pay the Medicare deductibles and co-insurance.
When will I start saving on Medicare costs?
On the date your Medical Assistance begins. As of this date, most of your Medicare cost savings should start.
You will usually need to be enrolled in EID for two months before your Medicare Part B premium ($144.60 per month) will stop. However, if you had another benefit that covers the Part B premium just before you enrolled in EID, you won’t have to wait two months. The other benefits that cover the Part B premium are Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB) or another kind of Medical Assistance.
How much will I save on Medicare Part D?
If you are enrolled in a Medicare Part D prescription drug plan and receive Medical Assistance through EID, your Medicare Part D costs will be greatly reduced. If your Medicare Part D plan has a monthly premium of $32.74 or less in 2020, Medical Assistance will eliminate all out-of-pocket costs for your Part D plan except for a very small co-payment for prescriptions ($1.30 for generic drugs; $3.90 for name brand drugs in 2020). If your Part D plan’s premium is higher than $32.74 per month, Medical Assistance will reduce the premium by $32.74/month in 2020.
What if I want to change Medicare Part D plans?
Most people enrolled in Medicare Part D plans can only change plans during open enrollment periods. If you are enrolled in Medical Assistance, though, you can change Part D plans at any time.
If you enroll in Medical Assistance through EID and your Part D plan’s premium is higher than $32.74 per month in 2020, you may choose to switch to a Part D plan with a lower premium to reduce your out-of-pocket costs.
Can I choose not to enroll in Medicare Part D and just have Medical Assistance pay for my prescriptions?
No. If you are eligible for Medicare and you receive Medical Assistance, you must choose a Medicare Part D plan to get prescription coverage (unless you have other prescription coverage, such as through your employer). If you don’t choose a Medicare Part D plan, Medical Assistance will not cover your prescriptions.
What if my Medicare Part D plan does not cover all of my prescriptions?
Medical Assistance may pay for some prescriptions if your Medicare Part D plan does not. A partial list of prescription drugs that Medical Assistance may cover can be found at http://www.providersynergies.com/services/documents/MDM_PDL.pdf. Medical Assistance covers many other drugs as well – over 99% of those on the market.
When should I choose a Medicare Part D plan if I don’t already have one and I enroll in EID?
If you are eligible for Medicare, you haven’t chosen a Part D plan, and then you enroll in EID, a plan will be chosen for you automatically. If you don’t like the plan that is chosen for you, you can change plans.
Note: Oddly enough, you can’t really choose a Part D plan before the system chooses one for you. If you do, the system will most likely replace your choice with a plan it chooses automatically. You should wait until you are automatically enrolled in a Part D plan, then choose a different plan if you prefer.