Online Insurance Guide

Medicare Comparison Chart

  Original Medicare    
  Part A
(Inpatient Services)
Part B
(Outpatient Services)
Part C
(Medicare Private Plans)
Part D
(Prescription Drug Coverage)
Coverage
  • Inpatient hospital care
  • Skilled nursing facilities (excluding long-term care)
  • Hospice
  • Some healthcare
  • Doctors’ visits and most medically necessary doctors’ services
  • Outpatient hospital care
  • Durable medical equipment (DME)
  • Prescription drugs that require DME to administer
  • Preventative care
  • X-rays & lab tests
  • Mental health care

PH-Specific Coverage

  • Tyvaso®
  • Flolan®, Veletri® or generic epoprostenol
  • Remodulin®
  • Ventavis®
  • DME (e.g., home oxygen)
  • Pulmonary rehabilitation (PR)
    * You may be limited to 36 PR sessions per lifetime
  • Allows members the option to select a privately managed care plan to replace original Medicare and its benefits.
  • Plans must provide all Part A & B services (may provide additional coverage), but may do so with different rules, costs and restrictions.
  • Part C is not a separate benefit.
  • Optional outpatient prescription drug coverage provided through private insurance companies.
  • Buying into Part D depends on your personal drug needs.

PH-Specific Coverage

  • Tracleer®
  • Letairis
  • Adcirca
  • Revatio®/Viagra®
  • Opsumit®
  • Adempas®
  • Orenitram®
Learn more about choosing a plan that meets your needs
Cost
  • No premium
    Part A is free if you or your spouse have worked and paid Social Security taxes for at least 10 years.

    You will pay a monthly premium if you have worked and paid taxes for less than 10 years.
Part A Cost Breakdown 2015
  • Monthly premium ($105.90)
  • Annual deductible ($147)
  • Coinsurance/ copayments
Part B Cost Breakdown 2015
  • Varies from plan to plan
  • Varies from plan to plan.
    Your annual deductible cannot be more than $320. Average national premium is $33.13.
  • Premiums and deductibles do not apply and copayments will be lower if you are enrolled in Extra Help – a federal program designed to help low-income individuals cover the cost of their prescription drugs.
  • High out-of-pocket costs during the coverage gap until you reach a catastrophic limit.
  • You may be charged an additional, permanent fee if you decline the Medicare Part D benefit when it is first offered to you and then later decide to purchase a Medicare Part D plan.
Part D Cost Breakdown 2015
Medigap

Medigap: Optional Plans to Supplement Original Medicare (Parts A & B)

Original Medicare does not cover everything. In addition to retirement options through employers, individuals eligible for Medicare have the choice of purchasing a Medigap (Medicare Supplement) policy that would help cover some of the gaps in Original Medicare's coverage.

Depending on where you live, there are ten standard Medigap plans, A-N.* Plan A is generally the cheapest (offering the least amount of additional benefits) and Plan L the most expensive (offering more benefits). However, coverage and premiums vary among plans depending on the company you buy it from.

*As of June 1, 2010, Medicare introduced two new plans, M and N. Plans E, H, I and J will no longer be offered, but Medicare consumers who already have these plans will be able to keep them.

Contact us with insurance questions, success stories or suggestions.

FacebookTwitterLinkedInYouTube

The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

801 Roeder Road, Ste. 1000, Silver Spring, MD 20910   Patient-to-Patient Support Line: 1-800-748-7274
Webmaster@PHAssociation.org
    Privacy Policy    Provide Feedback & Report Bugs

Designed by Matrix Group International, Inc.® | © 2015 Pulmonary Hypertension Association. All Rights Reserved.

NORD

The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas.