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Durango Medicare & More
Parts of Medicare
Medicare Part A
This is coverage for Hospitalization, skilled nursing, home healthcare and hospice.
Most people receive this for zero cost if you have worked more than 40 quarters and paid taxes toward
Medicare. If you do not have the 40 quarters of work history, depending on your work history, you will
pay between $274 per month and $299 per month. Enrollment into part A is automatic for those
collecting social security If you are collecting social security most people are automatically enrolled into
Part A at age 65.
Medicare Part B
Medicare Part B helps cover medical services such as doctor visits, medical testing,
durable medical equipment, vaccines, and certain other injections and infusions administered by your
doctor, as well as other medical services not covered under Medicare Part A. For the calendar year 2024 the base rate is $174.40
Medicare Prescription Drug Plans (Part D)
A Medicare Prescription Drug Plan (Also known as Part D) is coverage for your prescription drugs. These
plans may only be purchased through private insurance companies as there is not a Federal insurance
program for prescription insurance coverage. You may purchase a standalone plan or an Advantage
Plan that includes prescription drug coverage. In addition to your monthly premium paid and based on
your annual income, you may be assessed for an additional monthly dollar amount by Medicare called
IRMAA (Income Related Monthly Adjustment amount.
There are multiple stages to Prescription Drug plans which will impact how much you pay for your
prescriptions throughout the year. The stages are:
Deductible
This is the amount you must pay each year for your prescriptions before your Medicare drug plan pays its share.
Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $545 in 2024. Some Medicare drug plans don't have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.
Initial Coverage
These are the amounts you pay for your covered drugs after the deductible (tooltip if the plan has one). You pay your share and your plan pays its share for covered drugs. If you pay coinsurance, these amounts may vary because drug plans and manufacturers can change what they charge at any time throughout the year. The amount you pay will also depend on the tier level assigned to your drug.
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Under the standard drug benefit, once you and your plan spend $5,030 combined on drugs (including deductible) in 2024, you’ll pay no more than 25% of the cost for prescription drugs until your out-of-pocket spending (including certain payments made on your behalf, like through the Extra Help program) is $8,000.
Coverage Gap
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $5,030 on covered drugs in 2024, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Catastrophic Coverage
In 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made on your behalf, like through the Extra Help program), you’ll automatically get “catastrophic coverage.” This means you’ll pay nothing for your covered Part D drugs for the rest of the calendar year.
Part D Penalty
Although this is a voluntary program, if you do not purchase a drug plan during your
initial enrollment into Medicare or did not have creditable coverage through an employer past age 65
(even if you do not take any prescription drugs), a late enrollment penalty of 1% per month will be
added to your monthly premium and generally stays with you for life. The 1% penalty is based on the
national average price of prescription plans which is currently $34.70 for 2024. When the national
average price increases, your penalty will too as it is based on 1% of the national average.
Medicare Supplement plans (Medigap plans)
Medicare Supplement Insurance (also known as Medigap) plans are sold by private companies and help
cover some or most of what Original Medicare does not including copays, coinsurance and deductibles.
They may also provide coverage for foreign travel. Generally, these plans do not offer coverage for
hearing, dental or vision. You may see any Doctor in the United States as long as they accept Medicare.
Medicare Advantage Plans (Part C)
A Medicare Advantage Plan (otherwise known as Part C or MA plans) are plans that are sold and
managed by private companies. They combine the benefits of Original Medicare Part A and Part B plus
may include additional benefits such as hearing, vision, dental, gym membership, home delivered meals
and Over-the-counter allowances. These plans have maximum out of pocket limits to protect you from
massive out of pocket expenses. Many of these plans also include prescription drug coverage.
Advantage plans do not require you to answer any medical questions in order to enroll. You also have a
“trial right”. Meaning any time within the first twelve months of enrollment into an Advantage plan,
you may return to Original Medicare even if there is not an available enrollment period. You must be
enrolled in Original Medicare Part A and Part B and continue to pay your Part B Premium to be enrolled
in an Advantage plan. These plans work on networks, some HMO and some PPO. Using in-network
Doctors will ensure the lowest out of pocket costs for you.