Medicare Audit 2024

Without a Medicare Supplement policy or Medicare Advantage plan, a short $150,000 hospital stay including $100,000 in medical services under Medicare Parts A & B should cost about;

$1,632; Part A hospital inpatient deductible
+ $240; Part B deductible
+ $20,000; (20% medical services co-pay for $100,000)

= $21,872 for the Benefit Period, which could occur again within the same year, not including Part D prescription drugs
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Without a Medicare Supplement policy or Medicare Advantage plan. a $550,000 hospital stay of less than 60 days including $300,000 in medical services should cost about; 

$1,632; Part A hospital inpatient deductible
+ $240; Part B deductible
+ $60,000; (20% medical services co-pay for $300,000)

= $61,872, for the Benefit Period, which could occur again within the same year, not including Part D prescription drugs
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With a Plan G Medigap Supplement policy, a short $150,000 hospital stay with $100,000 in medical services under Medicare Parts A & B combined should cost about;

$1,776 ($148 Average 2024 Plan G monthly premiums x 12)
+ $240 Part B Deductible

= $2,016 Plan G Medigap 2022 "Maximum Out Of Pocket" limit (MOOP) per Benefit Period, not including Part D Drug Costs
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With a Plan G Medigap Supplement policy, a $550,000 hospital stay of less than 60 days including $300,000 in medical services should cost about; 

$1,776 ($148 Average 2024 Plan G monthly premiums x 12)
+ $240 Part B Deductible

= $2,016 Plan G Medigap 2022 "Maximum Out Of Pocket" limit (MOOP) per Benefit Period, not including Part D Drug Costs
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With a Medicare Advantage "Give Back" Contract, a short $150,000 hospital stay with either a $100,000 or $550,000 hospital stay of less than 60 days including $300,000 in medical services should cost about;

$8,850 "In Network" Medicare Advantage 2022 Maximum Out Of Pocket limit (MOOP), not including Part D Drug Costs, or $12,450 combined if "Out of Network" services are rendered.
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If you don’t enroll during the once in a lifetime Medigap Open Enrollment Period, during which carriers must approve applications for coverage regardless of any health issues, you can be denied a Medicare Supplement plan due to pre-existing conditions

Medicare Advantage contracts have annual enrollment periods with no health questions or underwriting ever.

If you enroll in a Medicare Advantage contract when eligible for Medicare, you can switch to a Medicare Supplement without underwriting within the first 12 months.
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Medicare is mostly prohibited from negotiating drug prices with pharmaceutical companies and Part D plans do not have MOOPs, but a “Catastrophic Phase”, when Medicare pays for the majority of drug costs.

2024 “Catastrophic Phase” coverage begins at $8,000, up from $6,550 in 2021.

Sometimes some Prescription Drug Plans with monthly premiums can cost less than drug coverage in some Medicare Advantage contracts.

Sometimes the lowest monthly cost plan can end up being the most expensive and vice versa.  For those who take more expensive drugs, it is imperative to evaluate prescriptions for each plan and compare costs and alternatives at least annually. 

Often, some Medicare drug plans don’t cover less expensive generic prescriptions.  
Check for discounts for cash or with non-insurance discount pharmacy programs and different sources.  Determine if name brand alternatives for uncovered generics are covered or if there’s better pricing for similar drugs.
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Hartzman Tax & Fiduciary not connected with or endorsed by the U.S. government or the federal Medicare program.  Visit Medicare.gov or HealthCare.gov for the most current information.  George Hartzman is an independently licensed Insurance Agent.  Official Medicare and ACA Program legal guidance is contained in the relevant statutes, regulations, and rulings.  Reasonable effort has been made to have this information represent the intent of legal contract language.  However contract language stands alone, and complete terms of any coverage is determined by policy documentation.