Chapter 2: Making Your Decision
Now that we know the one big decision you have to make, lets take a look at some examples of who might pick what, their monthly costs, and what their experiences will be like:
Scenario A — Mr. Smith
Mr. Smith is 68 years old. He is unhealthy, Diabetic, COPD, and needs frequent Hospital Visits.
He will most likely pick a supplemental plan so he can avoid having to pay for Hospital visits. If he needs to go to a hospital out of state, he can because his network is not restricted.
In addition to the supplemental plan, he will also need to pick up a prescription part D plan, and possibly a dental plan depending on his needs.
Coverage Analysis
For Mr. Smith, his coverage and monthly premium breakdown will look like such:
Part A: $0(assuming Mr. Smith has 10+ years work history with Social Security)
Part B: $174.70/month(2024 rate)
Supplemental Plan G: $150 ~ 200/month (vary based on location, age, and gender)
Prescription Part D: $10 ~ 80/month(vary based on medications and pharmacy preference)
Dental coverage: $50/month(vary based on location)
Monthly Total: approx. $384.70 ~ 504.70
What happens if he needs services?
After the $240 annual deductible from part B, Mr. Smith is covered 100% for any inpatient or outpatient services. He has no copay for any hospital stays, doctor/specialist visits, and any durable medical equipment that may be needed for diabetic conditions.
He also has the network flexibility to see any providers/hospitals in the country that accepts Medicare. The only copay will be for his medications, unfortunately, there isn’t a Cadillac prescription coverage on the market currently.
Scenario B — Mrs. JoneS
Mrs. Jones is 67 years old. She is very healthy, and goes for annual checkups and routine preventative visits. She mainly stays local and may take a few weekend trips here and there.
She will most likely go with an advantage plan that also includes prescription, dental, vision, hearing, and fitness benefits. Most advantage plans starts at $0/month so she will also be able to save on the premiums in case of a rainy day.
She is okay with referrals and have regular doctors that are in the advantage plan’s network.
Coverage Analysis
For Mrs. Jones, her coverage and monthly premium breakdown will look like such:
Part A: $0(assuming Mrs. Jones has 10+ years work history with Social Security)
Part B: $174.70/month(2024 rate)
Advantage Plan(Part C): $0-20/month (vary based on location)
Prescription Part D: included with advantage plan
Dental coverage: included with advantage plan
Monthly Total: approx. $174.70 ~ 194.70
What happens if she needs services?
When Mrs. Jones needs care, she will have to pay out of pocket expenses and copay depending on the service. Primary doctor visits are typically at no cost but specialist visits can range from $30-45 copay per visit. Specialist referral may be required depending on the plan’s network.
Hospital stays are typically a per day copay, such as $350/day for up to 5 days, after 5 days, she is 100% covered. Outpatient surgery is typically $300-400 copay per procedure.
All advantage plans also include what they call a maximum out of pocket, which limits her total copay in a given year. The number typically range from three to six thousand dollars depending on where she lives and how expensive the plan is.